


 MORBID 
MENTAL 





| HI SCHOU 














RELIGION AND MORBID 
MENTAL STATES 





\ UP FRINGE OS 
Se 


/ DEC 9- 1926. 
[The Wractical Gbetstianity Series <2} Jiggy > 
RELIGION AND 


MORBID MENTAL 
STATES 















VA BY 
H. I. SCHOU, M.D. 






TRANSLATED FROM THE DANISH BY 


W.’ WORSTER, M.A. 







THE CENTURY CO. 
New York London 






Copyright, 1926, by 
THE CENTURY Co. 


PRINTED IN U. 5. A. 


DEDICATED TO 
MY FRIENDS 
AMONG THE YOUNGER PRIESTS 
OF DENMARK 


ec Ra Dt 2 
: eee Hy Kate he a i) 
seit } sky Pena ee SAR 

Diet 





PREFACE 


The purpose of these lectures, which 
were delivered at the University of Copen- 
hagen, is to throw light on the relation be- 
tween religious soul-life and morbid men- 
tal states, by going through the principal 
disease groups in brief, and showing, for 
each group, the manner in which mental 
trouble affects the religious life of the in- 
dividual. The writer has endeavored to 
distinguish between morbid and _ healthy 
religious life—as far as any such distinc- 
tion can be made at all—as a guide to the 
clergy on this most important point. 
The spiritual treatment of mental cases is 
dealt with at length in a special section, but 
here also the writer endeavors to show 
where such treatment may be considered 
advisable, and where, on the other hand, it 
is likely to do more harm than good. 

The accounts of particular cases have 
been given with due regard to professional 


[ vii ] 


Preface 





secrecy, all personal data being omitted, 
and the cases so presented as to render 
identification impossible. 

_ The work is doubtless far from attain- 
ing the innermost depth of truth, or such 
precise expression as the author might have 
wished. If so, some excuse may perhaps 
be found in the fact that in this field of 
work, a very difficult one in itself, there is 
an almost complete lack of literature on 
the subject; and the view here set forth is 
from first to last the author’s own. This 
is probably one of the first attempts on the 
part of a medical man to study the reli- 
gious psychology of the insane. 

I hope that this little book, despite its 
imperfections, may afford some informa- 
tion of value to those intrusted with the 
care of souls, and prove of use to them in 
dealing with insane and nervous patients, 
who sorely need our charity and sympa- 
thetic understanding. 

H. I. Scuou 
Dianalund, September 1924 
[ viii | 


CONTENTS 


CHAPTER 
I. RELIGION AND MELANCHOLIA . . 
II. Revicion anp Manic-DEpREssIvE 
TNSA NTT Yi oa Co ea ove ore Le Wek 
III. Revicion anp INcuRABLE ForMs or 
INSANITY he cee eae Ur eng : 
IV. Rexicion as a Cause or INSANITY, 
AND SPIRITUAL. TREATMENT OF 
THE INSANE SOND AILLP Rates Maa ma ae aye RS 
V. ReLicion aNnp NERVOUSNESS ae 
VI. Reuicion anon Mentat DecEenerRa- 


TION . . ° ° ° ° . 


[ix] 





RELIGION AND MORBID MENTAL 
STATES 





RELIGION AND MORBID 
MENTAL STATES 


LECTURE I 
RELIGION AND MELANCHOLIA 


HAVE. been invited, as a medical 

man, to put before you, as priests, some 
information as to the relation between re- 
ligious soul-life and morbid mental states ; 
and I take it that what you want is prin- 
cipally such information as may be of 
practical use to yourselves as spiritual ad- 
visers. You want not so much a discus- 
sion of problems or a dissertation on reli- 
gious psychology,—which our subject in 
itself might well suggest,—but rather some 
practical equipment, some concrete in- 
formation on matters which you may, and 
will, encounter in the future. 


[3] 


Morbid Mental States 





Every one of us who is concerned with 
the spiritual welfare—or the reverse—of 
his fellows will, as experience shows, be 
brought into contact with a number of 
human beings in spiritual difficulties, peo- 
ple in a critical mental state, but at the 
same time diseased, diseased in soul and 
body. ‘These people need a very par- 
ticular form of treatment, and a far more 
intensive understanding than we are called 
upon to give to persons of normal and 
healthy mind. The priest and the doc- 
tor, the lawyer and the teacher have again 
and again to deal with these mental in- 
valids; and the first great thing to realize 
is, that these persons are il; they are suf- 
fering from disease, and therefore differ- 
ent from those we have to deal with ordi- 
narily. And when we try to put them right 
as regards their spiritual life, it can only 
be done by taking into consideration their 
condition as a whole—their state of mind 
and body. It is a mistake to pick out a 
single phenomenon from their spiritual life, 


[4] 


Religion and Melancholia 





such as, for instance, their religious ex- 
perience, and treat that by itself. Fatal 
errors may be committed in this way, often 
leading to harm instead of good. 

But with these morbid phenomena in 
view, we discover that the number of peo- 
ple suffermg from mental trouble is far 
greater than generally supposed. Not in 
the sense of incoherent utterance or ec- 
centric behavior, of ‘‘hearing voices,” 
“seeing visions,” and the like; it is simply 
that their mental life at some point or an- 
other is awry, abnormal; it has got off the 
track which our mental life normally fol- 
lows; and persons so affected are what we 
should describe as “odd” or “queer.” 
Very likely they are not aware of it them- 
selves; or, at least, will not always admit 
it. But none the less it is so. And if we 
do not meet them with some psychological 
understanding, and a certain degree of 
psychiatric knowledge, we shall never be 
able to help them in their spiritual life. 

A difficulty here, however, lies in the 


[5] 


Morbid Mental States 





fact that morbid mental states and their 
relation to religious life are in most respects 
as little known to young clergymen as 
certain aspects of theology to young doc- 
tors. And I should like to draw attention 
to this fact at once, as a regrettable state 
of things, which should, if possible, be 
amended. It is undoubtedly wrong that 
young theological students, when they com- 
mence their task in life as spiritual advis- 
ers, should be ignorant of the most elemen- 
tary principles of psychiatry, and thus un- 
able to recognize, and adequately deal with, 
the many cases of people suffering from 
some mental trouble, pathologically abnor- 
mal, whom they must inevitably encoun- 
ter in their work. Every mental special- 
ist in the medical profession has had oc- 
casion to learn from his own experience 
that the clergy are ill equipped in this re- 
spect. Their studies for holy orders make 
no provision for this field of work. Such 
psychiatric and neurological knowledge as 
the clergy do possess has necessarily been 


[6] 


Religion and Melancholia 


acquired either by practical experience— 
and many of the older men have learned a 
great deal in this way—or by studying the 
question for themselves. This last, how- 
ever, is by no means easy, owing to the 
lack of suitable works on the subject. 

As to the cause of this, the question why 
theological students are sent out into the 
world with no psychiatric knowledge, when 
they will inevitably have to deal with a 
number of morbidly religious cases, I 
should hike to draw attention to two points. 
Firstly, the study of morbid mental con- 
ditions has of late years been left entirely 
to a few medical specialists, and is no 
longer common property, as it was in ear- 
lier times. There was a time when not only 
ordinary medical practitioners, but also the 
clergy, as such, ministered to minds dis- 
eased. In the Middle Ages, for instance, 
it was the monks and nuns who treated the 
insane; their work in this field was not ex- 
tensive, it is true, but they had at least 
abundant opportunity of studying insane 


[7] 


Morbid Mental States 





persons and their religious difficulties. 
And in ancient times, the offices of priest 
and medical practitioner were almost al- 
ways combined. But in the course of the 
last hundred years, the study of psychiatry 
has passed completely into the hands of 
the medical profession, and here again to 
the specialists, so that these and these alone 
are, in our modern society, capable of deal- 
ing rationally, and on the basis of experi- 
ence, with insanity and the unsound mind. 
The clergy, then, are at present left out 
altogether, and it will probably be very 
difficult for them to make fresh progress, 
owing to the fact that insanity is now re- 
garded as mainly a defect in the human 
brain, and thus a matter to be dealt with 
in all essentials on the same lines as other 
physical ailments. 

The second reason why candidates for 
holy orders have not until now received 
any instruction in psychiatry is that at 
the close of the past century, when the 
great discoveries of medical science were 


[8] 


Religion and Melancholia 


being made, and when also psychosis, once 
an object of philosophy and metaphysics, 
became an object of natural science, a 
tendency to medical materialism arose 
among medical men, which found its ad- 
herents not least—as we psychiatrists are 
forced to admit—among the mental spe- 
cialists. Many of our leading authorities 
on mental diseases have been out-and-out 
materialists. They regarded the human 
brain not only as the primary object, but 
as the most important, the only thing that 
had any real existence. ‘The soul was to 
them a secondary matter, a derivative; 
properly speaking, indeed, it was nothing 
at all, for all that could be seen was the 
vascular and cellular structures in the 
brain, with the reactions of which were as- 
sociated as “symptoms,” certain psychic 
processes of various kinds. 

But the clergy could not, or would not, 
receive instruction from these material- 
istic medical authorities. The two lines of 
study lay so far apart that no reciprocal 


[9] 


Morbid Mental States 


influence was possible. And as a con- 
sequence we find, in place of peace and 
concord between psychiatrist and priest, 
—which ought, one would think, to be the 
natural state of things, seeing that both 
aim at improving the mind,—there arose 
dissension and hostility. So much so, in- 
deed, at times, that the two parties quar- 
reled over the patients, each trying to 
snatch the mental cases from the other, 
each side believing that they alone were 
qualified to deal with such cases. This 
has been more especially the case in Ger- 
many. 

It is to be hoped that this is now a thing 
of the past. And we have perhaps good 
grounds for believing that it is so. For 
the more medical men realize the rights of 
the soul as compared with the physical 
life, and the more theologians recognize the 
importance of the body in its effect on 
every form and phase of soul-life, the 
more codperation will be possible between 
the two. Doctor and priest will seek to 


[10] 


Religion and Melancholia 





learn of each other on the points where 
they have interests in common, instead of 
quarreling; and their suffering fellow-men 
will benefit accordingly. 

From this point of view, then, I ven- 
ture to express the hope that these lectures 
may be of some use to those about to en- 
ter the priesthood. It was a welcome in- 
novation that a doctor of medicine should 
have been invited to instruct an audience 
of theological students on matters so closely 
knit up with their own province; and it is 
to be hoped that the example set by the 
University of Copenhagen may be widely 
followed. Doctors and clergymen have 
much to learn from each other, and nothing 
but good can result from their codperation. 

By a morbid mental state we under- 
stand some disturbance of the mental proc- 
esses proceeding from disordered functions 
in the human brain. 

Such pathological conditions may be 
roughly divided into the following three 
main groups :— 


[11] 


Morbid Mental States 


1. Mental diseases. 

2. Nervous diseases. 

3. Mental disturbance or abnor- 

mality. 

We shall here consider each of these three 
groups separately, devoting the first four 
sections to mental diseases, the fifth to nerv- 
ous diseases, and the sixth to mental ab- 
normality or degeneration. Each section 
will be divided on the same lines, taking 
first a brief outline of the nature and prog- 
ress of the disease in question, then con- 
sidering its relation to religious life, with 
the various pathological religious symp- 
toms, and finally the treatment of the 
disease—more particularly our attitude, as 
doctors or priests, toward mental symptoms 
of a morbidly religious character. 


The commonest and most typical of the 
ordinary mental diseases is melancholia, 
with its preliminary stage: mental depres- 
sion. 

By mental depression we mean a disease, 


[12] 


Religion and Melancholia 


the predominant symptom of which is that 
a person’s attitude toward life is affected. 
A normal human being who has, perhaps, 
up to now been cheerful and well balanced 
enough, as we most of us are when things 
go fairly well with us, suddenly becomes 
gloomy and sad, melancholy and reserved. 
The touch of melancholy that is latent in 
every human mind, especially when the 
shadows lengthen toward evening and the 
body is tired with the toil of the day, 
spreads and affects the sufferer’s outlook 
upon life as a whole. For persons thus af- 
fected, life becomes hateful; its joys are 
lost sight of, and a mist obscures the way. 
Thought becomes difficult, and mental ac- 
tivity comes to a standstill. Mental proc- 
esses are hampered, and, with them, all 
initiative and power of action. A man, 
once busy and capable, sits idle and dull. 
Life no longer wakes in him the need of 
action which is characteristic of the normal 
human being. He becomes a silent, pas- 
sive, and melancholy onlooker. 


[13] 


Morbid Mental States 


What can be the cause of this depres- 
sion? Asa rule, it is impossible to say for 
certain. Nothing particular has _ hap- 
pened to the man; he has not lost money or 
been disappointed in love; no personal be- 
reavement can be found to account for his 
state. He still possesses all that ordina- 
rily makes a person happy. ALI the same, 
he becomes a prey to deep and inexplic- 
able weariness of life. He, or she, suffers 
from a sadness of the soul, an indefinable 
melancholy which tinges every thought, 
and in a short space of time transforms the 
active citizen, the cheerful, light-hearted 
neighbor, to a person taciturn, reserved, 
passive, and obviously suffering, who shuts 
himself up in his own room and shuns his 
fellows, his mind occupied with heavy 
thoughts. If we ask such a person what 
is the matter, he will as a rule give no an- 
swer, for it tires him to talk at all. But if 
we persist, we may perhaps learn that he 
is sick and tired of the whole thing; he feels 
as if something inside him had come to a 


[14] 


Religion and Melancholia 


standstill. Things that he cared for be- 
fore, such as his home and children, are 
now matters of indifference. His daily 
work, that he used to find easy and inter- 
esting, is now a burden. It is as if his 
brain-cells had stiffened to the core; or, 
as another patient put it, ‘tas if his feel- 
ings were stuffed up with cotton-wool.” 

When a person gets into this state, there 
is reason enough to feel sorry for him, for 
there are few forms of suffering so hard to 
bear as those imposed upon a human being 
in a state of mental depression. ‘There are 
few pains so intense as those of the mind; 
they are far worse than bodily pain. Bod- 
ily pain is, after all, to a certain extent 
objective, a thing we can at least now and 
then consider as if from without. But 
mental suffering attacks the individual at 
the core, and therein lies its sting. 

Now, a patient suffering from mental 
depression will often exhibit certain physi- 
cal symptoms, which, to the expert obser- 
ver, confirm the impression of actual dis- 


[15] 


Morbid Mental States 





ease—a physical disease. The patient 
complains of headache, giddiness, a tired 
and heavy feeling, dullness, difficulty im 
breathing, palpitation, loss of appetite, 
constipation, bad breath, etc. *Often se- 
vere insomnia sets in, with troublesome 
dreams and painful fits of terror, amount- 
ing at times to positive fear of death. 
There may also be unpleasant sensations 
in the region of the heart, “‘as if the heart 
were going to stop,” and so on. 

Very often—almost, indeed, as an inevit- 
able accompaniment to the general depres- 
sion—we find religious doubts and trouble 
of mind. And these may, moreover, occur 
in earnest Christians, who have lived a 
long life in God’s fold, as well as in per- 
sons indifferent to all religious considera- 
tions, who have never troubled themselves 
about such things. All experience a feel- 
ing of internal chill, a callous obduracy, a 
sense of harsh injustice, calling forth in 
them a protest against the Highest. In 
extreme cases, such persons may be in- 


[16] 


Religion and Melancholia 


spired with a positive hatred of God. And 
when the patient is a Christian, this leads 
to a painful tension in the mind between 
his former faith and these new doubts— 
that is, to a serious conflict in the soul. 
This state of depression may be ren- 
dered especially painful and severe to 
many, by the lack of sympathy in those 
about them. They are exhorted to “pull 
themselves together” and not give way to 
their feelings. They are told to take more 
exercise, to eat this or give up that, and, 
above all, to leave off worrying about such 
things. It is worry that has upset them, 
they are told; and well-intentioned friends 
insist on trying to “cheer them up” by givy- 
ing them something else to think about. 
They are advised to go out more to parties 
and theaters, read good books, and go for 
long walks. But all this time their state 
is growing worse. ‘They become more and 
more weary, hopeless, and_ indifferent. 
And we should indeed admire the energy, 
the enormous effort, which many such pa- 


[17] 


Morbid Mental States 


tients do exert by simply getting up in the 
morning at all, or carrying out the simplest 
transactions in their business. They them- 
selves can tell us what it cost them—after- 
ward, when they are restored to health. 
For they are restored to health. The 
good thing about this disease is that it gen- 
erally passes off after a time. The state 
of depression is transient—that is to say, 
when it is a true case of depression. The 
duration cannot be given with certainty; 
it may vary between a few months and a 
few years; from three to six months is not 
uncommon. The trouble may wear off 
gradually, or it may vanish all of a sud- 
den ; but it always disappears somehow, and 
that completely. No trace of it remains. 
There is no weakening of the intelligence, 
no change in the personality, no defect in 
the human feelings. It is of great impor- 
tance to the medical man to be able to 
give relatives this assurance; and one 
should, of course, assure the patient him- 
self repeatedly of the same thing, though 


[18] 


Religion and Melancholia 


the patient will rarely believe it as long as 
the depression is still present. 
Unfortunately, the duration of the dis- 
ease is little amenable to any form of treat- 
ment. It runs its course and takes its 
time, independently of external conditions 
and medicines. But the physician who 
knows his business can to a great extent 
alleviate the symptoms by the use of vari- 
ous medicines, such as opium in small 
doses, veronal, and other sedatives; and in 
particular by ordering rest and quiet, and 
freedom from all work or responsibility. 
Rest in bed is often used in cases of depres- 
sion, and is an excellent specific; for it 
must be remembered that we are dealing 
with a physical disease, and the brain needs 
rest and quiet, the same as any other af- 
fected organ. Moreover, in cases of de- 
pression, various peculiar processes take 
place in the body, and the most recent 
theories suggest that the trouble arises 
from a kind of self-poisoning, proceeding, 
it may be, from the intestines or from some 


[19] 


Morbid Mental States 


small glands in the body which fail to per- 
form their proper functions. These are, 
however, only hypotheses at present. 

I will now give some instances of men- 
tal depression accompanied by slight reli- 
gious obsession. 


Cast 1.—This was a young girl of 
twenty-two, who stated that her aunt suf- 
fered from melancholy and had been for 
some time in an asylum, where she was sub- 
ject to severe “religious unrest.” With 
regard to herself, the girl stated that she 
had formerly been healthy, but was at times 
depressed. It came over her suddenly, she 
said, and then everything looked dark; 
she became irritable over trifles, and dur- 
ing these periods sometimes felt like throw- 
ing herself in front of a tram. 

During the past six months her depres- 
sion had been particularly bad; she was 
also subject to fits of fright—‘‘afraid she 
was going to die.” These came especially 
in the evening when she had gone to bed; 


[20] 


Religion and Melancholia 





and she would then feel that she was sure 
to die in the night—and what then? 
Where would she go to after? What was 
there after death? 

In conjunction with this fear of death, 
religious unrest appeared, though she had 
never previously been interested in religion. 
She said she had always hated the churches 
and the priests, because “they took money 
for it”; but she would gladly now believe 
in the teaching of the Church. But she 
could not; she felt that she was wicked and 
sinful, but she could not accept God’s 
grace. ‘There was no peace for her. God 
would no longer have mercy upon her, 
though she prayed to Him every day. 
Prayer brought her no comfort, no rest. 
She also stated that her feelings toward her 
relatives had changed ; she had become cold 
and blunted; was now careless and indif- 
ferent about everything; her work seemed 
harder; she was always tired and lacking 
in energy. Slept badly, lack of appetite, 
constipation, etc. 


[21] 


Morbid Mental States 


This patient looked pale and thin, she 
spoke slowly and in a low voice, presenting 
in every respect the impression of a typical 
case of depression. Examination of her 
physical state revealed nothing abnormal. 
She was then told that hers was a case of 
mental disease, not “‘wickedness,” as she 
said; 1t was merely a typical disease of the 
brain. But this she refused to believe. It 
was wrong, she argued, to put it off by say- 
ing she was ill, for it was wickedness all the 
same; she was sure of that. 

A course of treatment was then ordered, 
with opium and mild sedatives, rest in bed, 
and lying out in the garden. With this 
treatment, the depression gradually wore 
off. The patient’s mind grew brighter, 
fear diminished, and the religious unrest 
disappeared altogether. I saw her some 
time back, and she was then completely 
well, thoroughly at ease, cheerful and ac- 
tive. She no longer talked of religious 
matters. 


[22] 


Religion and Melancholia 


Case 2.—This was a woman of forty- 
five, who had always previously been in- 
terested in religious matters, a church- 
goer, and taking part in the life of the con- 
gregation. Stated that she had at times 
suffered from melancholy, and had from 
childhood been inclined to take things ra- 
ther seriously; but not, she considered, in 
any morbid degree. She had had a good 
deal of trouble in her life. 

For the past few months she had been 
greatly depressed and seriously hampered 
in mental activity. Everything seemed a 
trouble to her; she had to force her- 
self to do every little thing. She also 
had a feeling that every one was more or 
less in trouble; that life altogether was 
more a burden than a pleasure. Her reli- 
gious life, too, was altogether upset. The 
sense of being at peace with God, which 
she had known so well in former days, had 
completely left her. Her joy in being 
saved had vanished; she was indeed most 


[23] 


Morbid Mental States 





inclined to believe herself utterly lost; or, 
as she herself expressed it, “dead in life.” 
There were a number of physical symptoms 
which I need not mention here, but no 
demonstrable physical disease. 

The patient presented the appearance of 
one in spiritual distress and great religious 
trouble; she had several times applied to 
the clergy. The last priest she went to 
realized that she was ill and sent her to a 
doctor. It was explained to her, as in the 
previous case, that she was ill, and that 
illness was the cause of her trouble; this 
relieved her perceptibly, her intelligence 
being unaffected. An improvement in her 
circumstances was then effected—a domes- 
tic conflict being removed—and with suit- 
able physical and mental treatment she 
gradually recovered. Her former calm 
in matters of religion returned, and she 
took part once more with pleasure in the 
parish work. During the period of de- 
pression, also, she gained experience which 
she declared she would not be without. 


[24] 


Religion and Melancholia 


A great number of instances might be 
quoted of mental depression accompanied 
by a religious element, but this will not be 
needed here; the examples already given 
can be supplemented by any one from his 
own experience. ‘The trouble in such cases 
is one of very common occurrence, a dis- 
ease which every spiritual adviser will en- 
counter again and again. The great 
thing is to remember that it is an actual 
disease, and that the patient must accord- 
ingly be placed under expert treatment. 


We will now pass from depression to 
mental diseases proper, and first of all the 
disease known as melancholia. 

In melancholia, the feeling of discontent 
becomes positive misery. The sufferers 
feel that life is not merely gloomy or un- 
pleasant, but positively dreadful, a thing 
to fear. ‘They are in despair at having to 
live at all. The obstruction of their men- 
tal powers is now so advanced that they are 
altogether dumb toward other people, and 

[25] 


Morbid Mental States 


entirely incapable of carrying out any sort 
of work. 

On going the rounds of an asylum, we 
find these patients in bed in a ward, where 
they either lie covered up in the bedclothes, 
unwilling to see any one, or sit up in bed 
with desperation in their faces and an 
expression of the greatest mental suffering. 
The forehead is wrinkled, the eyes are red, 
there are deep furrows round the mouth, 
and the complexion is pale and wan; they 
lie there in silence, wringing their hands, 
as they await the doctor’s visit. If we ask 
them how they are, they will as a rule make 
no answer. If the question be repeated, 
they shake their heads and say they are 
“very bad indeed.” And if we press them 
persistently, we learn that there is no hope 
for them now, they have done so much that 
was wrong; they are the most sinful of hu- 
man creatures; they have sinned against 
God; they are lost! ‘Tears come into their 
eyes, and they can hardly utter their words. 
Their mental processes are hampered; they 


[26] 


Religion and Melancholia 


can hardly associate their ideas. They 
are lacking in all initiative and have to be 
helped in everything, often even with their 
food. 

And if we try to comfort one of these 
patients, it will in nine cases out of ten 
prove fruitless. The patient cannot be 
comforted, and that is one of the symptoms 
of his condition. For if he could be com- 
forted, it would not be a case of insanity, 
or, at any rate, not of melancholia. One 
patient may perhaps admit for the moment 
that his complaints are unreasonable and 
that he has done no more harm than many 
others; but the feeling of misery over- 
whelms him again the next moment, and he 
will say: “Yes, but, doctor, it ts true all 
the same. I have ruined my life; I am lost; 
I know it. Help me.” 

Here we come to a central point in the 
conception of melancholia, and one of ex- 
treme importance to the spiritual adviser, 
namely, the patient’s self-reproach. 'This 
is the predominant symptom in religious 


[27] 


Morbid Mental States 


melancholy, and one that often leads the 
sufferers to seek counsel of their pastor. 
And it is these self-reproaches that the 
priest will first attempt to treat—by refer- 
ences to the Scriptures, for instance—in 
the belief that he is dealing with a normal 
consciousness of sin or the confession of a 
normal human being. 

And how do these self-reproaches ap- 
pear? 

They may begin very lightly, as a gen- 
eral underestimation of personal value, a 
sense of unworthiness which makes the 
patient quiet and silent, but not far ex- 
ceeding what is normal. The patients may 
complain, for instance, that they have not 
been so good as they ought to have been, 
have not deserved the kindness shown them, 
or the fortunate conditions under which 
they live; some fault, some false step in 
their past life now recurs to their mind, 
and they are busy with it day and night. 
But even in the lives of normal human be- 
ings such periods of reckoning may occur, 


[28] 


Religion and Melancholia 


and these are, perhaps, not the least fer- 
tile in religious respects. It is difficult, 
then, to form any diagnosis at the present 
stage. 

But melancholia goes farther than this. 

The patients begin to feel they are not 
worthy to live, have not deserved the food 
they eat; they are the greatest sinners that 
ever lived on earth, worthy only to be de- 
stroyed, and so on. Utterly insignificant 
things from their past life crop up and as- 
sume terrifying dimensions in their dis- 
ordered imagination. One patient, for in- 
stance, complained that she had _ stolen 
sugar from the pantry when a child; an- 
other that she had worn her dresses cut too 
low at the neck in childhood; a third was 
agonized by the thought that she had “‘al- 
most certainly” once cheated a little—a 
matter of a few shillings—over the income 
tax, and insisted on our writing to the 
authorities to say what a wicked and un- 
trustworthy person she was. 

The self-accusations of such patients 


[29] 


Morbid Mental States 





may be based on matters entirely imagin- 
ary ; things they invent out of their own in- 
tense, unresting sense of guilt to “prove” 
how base they are, and how utterly de- 
praved they always have been, but with no 
foundation whatever in reality. One re- 
spectable old shopkeeper declared that he 
had stolen all he possessed; the fortune he 
had amassed by care and industry was but 
the fruits of cheating and fraud. “Nota 
single penny have I earned by honest 
work,” he declared. An old lady, upright 
and refined, asserted that she had killed 
her husband by “poison.” How? Well, 
the last night of his life she had given him 
one drop more of the sleeping draught 
than the doctor had ordered, and that had 
killed him; and so she was a murderess. ~ 
But what we are particularly interested 
in is self-reproach of a religious character, 
the morbid sense of guilt. And here we 
must say that the feeling of having sinned 
against God can, in cases of melancholia, 
attain an astonishing intensity. The auto- 
[30] 


Religion and Melancholia 


biographies of the insane will show us 
what it means to suffer the torments of hell. 

It is characteristic in this respect that 
both religious and irreligious persons seem 
inclined to accuse themselves before God 
when the waves of melancholy surge over 
their soul. We gain here some remark- 
able information as to the spread of the 
religious instinct and its tendency to as- 
sert itself in quite primitive fashion when 
once the outer mask is dropped. Persons 
of all ages, from all classes of society, with 
all views of life, and at all stages of mel- 
ancholia complain that they have sinned 
against God. They have not sought Him 
while it was time; they have not been to 
church; they have lost the power to pray, 
and—in the case of Christians—they no 
longer have the feeling of being saved; 
they are cast out and utterly lost; they can 
feel the devil has got hold of them, and 
hell is about to swallow them up. 

It is a very common thing to hear pa- 
tients in a state of severe melancholia de- 


[31] 


Morbid Mental States 





clare that they have sinned against the 
Holy Ghost, or have committed the sin 
for which there is no forgiveness. 'This 
declaration is very often heard, and in such 
cases it is virtually useless to refer to the 
Scriptures or any other authority. ‘The 
patients know better. They have cften 
heard or seen that they are lost. 
Hallucinations generally play no small 
part in the picture of melancholia, and it 
is necessary for laymen also to know some- 
thing of these hallucinations, as it is only 
by this means that we can explain cer- 
tain distressing and fast-rooted fixed ideas. 
By hallucinations we mean _ sense- 
impressions having no external cause, but 
arising from within, in the brain. That 
is to say, the insane person hears, sees, 
smells, tastes, or feels things which have 
no existence in reality. And we speak of 
hallucinations of sight, sound, taste, and 
smell, etc. ‘These hallucinations are the 
result, presumably, of some irritation of 
the nerve centers pertaining to the respec- 


[32] 


Religion and Melancholia 


tive organs, affecting either the nerves 
themselves or the brain-cells, and due to 
insanity. 

Hallucinations are very common in cases 
of melancholia, and are often of a distress- 
ing character. ‘The patients hear voices 
telling them they are wicked, they have 
done wrong, they are to be shot or burnt, 
tortured or beheaded. They see visions, 
in the form of black figures, demons, coffins, 
flaming swords, or the like. They can 
taste poison in their food, smell sulphur 
in the room; they undergo experiences of 
a highly dramatic nature, such as war or 
murder; and in these they find confirma- 
tion of the idea that they themselves are 
doomed to perish. Obviously, these hal- 
lucinations must be of great importance 
to their melancholy fixed ideas, rendering 
them more persistent and horrible than 
they otherwise would be; the hallucinations 
are to some extent actually the cause of 
the fixed ideas and their sole explanation. 

The patients naturally suffer greatly 

[33] 


Morbid Mental States 


from fear as a result of these distressing 
mental experiences. They get out of bed 
and run about the room, or lie drenched in 
perspiration with the clothes over their 
heads. They sleep badly at night, lose 
weight, and look pale and worn. Not in- 
frequently, also, they refuse all food and 
have to be fed through a tube; and it is 
not unnatural, as a result, that such pa- 
tients develop in course of time a predomi- 
nant idea of putting an end to their lives. 
Suicide is one of the greatest perils that 
threaten these patients. This should al- 
ways be borne in mind; and these patients 
should therefore always, without excep- 
tion, be placed in an asylum. 

I will now give some instances of mel- 
ancholia where the disease was attended by 
a particularly marked religious element. 
These are, of course, the types of patient 
that you are most likely to meet with in 
your work as spiritual advisers. 


Case 3.—At a nerve clinic in Copen- 


[34] 


Religion and Melancholia 


hagen there was a man of middle age, an 
engine-driver from Copenhagen, formerly 
a cheerful and sensible enough fellow, liv- 
ing in the ordinary way as so many others 
do, without any thought of more serious 
things. He did not go to church. One 
day he begins to feel burdened with life, 
unhappy, weighed down in mind, with no 
interest in his work, no feeling for those 
nearest to him. He thinks he must give 
up his post, he is not worthy to live, he is 
a great sinner before God and man. He 
now begins going to church, but it does not 
make things better; goes to meetings, but 
still with no effect; and one day he 1s dis- 
covered in a woodshed with a rope round his 
neck. He is cut down at the last moment 
and sent toa nursing home. Here the pa- 
tient exhibits all signs of melancholia: he 
hides himself away, busy with his own 
thoughts, troubled, unhappy, will take no 
food, and reproaches himself with various 
things, as, for instance, not going to 
church. Every time the doctor comes 


[35] 


Morbid Mental States 


round he complains of not having sought 
God before; now he receives revelations 
from God, and sees God the Father 
Himself; voices tell him he is lost and 
is to be tormented through all eternity. 
He often asks the doctor to plead for 
him, to pray for his salvation, and he 
reads his Bible, but in such a manner 
that it has to be taken from him. 
This goes on for six to eight months; then 
he begins to get better. The hallucina- 
tions wear off, the fixed ideas begin to dis- 
appear, the depression is lightened. And 
in the course of a few months he is once 
more the old, steady, contented engine- 
driver, no longer worrying himself about 
higher things. All consciousness of sin 
and self-reproach seem to have vanished. 
All real religious longing is as alien to him 
now as before he was ill—as far as this can 
be ascertained by others. 


Case 4.—This was a young man of 
eighteen, who had always been steady, 


[36] 


Religion and Melancholia 


cheerful, and intelligent; he had the best 
of recommendations from the places where 
he had been, and was a regular attendant 
atthe Y. M.C. A. At one of the meetings 
here he suddenly fell on his knees and 
moaned aloud, “My sin, my sin!” He is 
somewhat confused, and talks of trifles in 
his previous life which, he says, have made 
God angry with him. He is taken home, 
and it then transpires that he has for some 
time past been “sort of downhearted,” tac- 
iturn, reserved, and bad at his work. He 
is taken to Section VI (the municipal 
hospital for nervous diseases in Copen- 
hagen), and while here he hides under the 
bedclothes and refuses to speak to the doc- 
tors. He will not eat, but lies there, mut- 
tering something about his own wickedness 
and that he is doomed to perish; now and 
again he gets out of bed, falls on his knees 
and prays aloud; at other times he becomes 
violent, flings the bedclothes across the 
floor, knocks over the tables, and attacks 
the other patients. He is removed to St. 


[37] 


Morbid Mental States 


Hans (the municipal asylum in Copenha- 
gen), and here he lies with closed eyes. 
When asked why he will not open his eyes, 
he answers, “I have sinned against the 
Holy Ghost.” One day he declares that 
he has heard God’s voice in the spirit, and 
another that he has been hypnotized by 
““God’s people.”” ‘There are various symp- 
toms of melancholia, and persistent self- 
reproaches and ideas of sin, which among 
other things prevent him from eating; he 
is “not good enough for the food.” And 
there are voices, too, telling him not to eat. 
The disease proceeds in this fashion for a 
couple of years, then gradually it clears 
off, and in six months he 1s, to all appear- 
ances, completely recovered. I met him 
some months ago on the railway-station at 
Roskilde; he looked well and spoke natu- 
rally and pleasantly of his work. 


Case 5.—This patient was an old Swede, 
who had for many years worked hard for 
his daily needs, but had lived a spiritual 

[38] 


Religion and Melancholia 


and Christian life as far as he was able. 
He now believed he was possessed by the 
devil. True, he could not explain pre- 
cisely what he meant by this, as his mel- 
ancholy state of mind hindered his speech, 
but he did say that the Evil One had 
‘taken him by the throat” and tried to suf- 
focate him, and that his own previous at- 
titude toward God had been hypocrisy. 
If asked at visiting time how he was get- 
ting on, he answered regularly that he was 
‘plagued by the devil.” He managed to 
explain, however, that there were some evil 
spirits inside him which were wearing him 
out from within, “but,” he added, “when 
Christ walked on earth, He drove out the 
evil spirits from those possessed, and no 
doubt He can do the same still.””, The mel- 
ancholia fluctuated for several years, but 
there has lately been some tendency to im- 
provement, and he now talks less of his ob- 
sessions. 


To these three examples we might add 
[39] 


Morbid Mental States 





many others. I call to mind a young 
priest who told me that he had been obliged 
to preach every Sunday for months despite 
incipient melancholia. It is hard to real- 
ize the mental agony which such a state of 
things imposes on a human being. And I 
remember the leader of a young men’s as- 
sociation, who told me how, during a pe- 
riod of depression, he had to deliver his 
regular talk to the lads on “Courage” and 
the like; but, when he came back to his own 
room, fell on his knees and sobbed aloud in 
terrible self-accusation. Both these men 
were greatly relieved to learn that they 
were suffering from an actual disease, and 
thus, being ill, must be exempt from work 
and responsibility and placed under med- 
ical treatment for a time. 

I have now endeavored to give a survey 
of the two principal forms of mental suffer- 
ing: depression and melancholia, with their 
relation to the religious life. If my own 
description has been poor, I hope that the 
examples I have quoted may afford some 


[40] 


Religion and Melancholia 


idea of the complicated suffering involved. 
The main thing, to my mind, is to realize 
that we have to deal with actual diseases. 
It is not an empty phrase or a pious fraud 
when we doctors in such cases say to the 
sufferer: ‘‘Your self-reproaches are not a 
sign of wickedness, but a symptom of dis- 
ease. It means that you are ill and must 
go to bed and take medicine. And you 
must give your brain a rest, give it a 
chance to get well. As for your religious 
doubts and fears, they may disappear as 
the mental disturbance clears up; but in 
any case, they must take second place for 
the present.” 


[41] 


LECTURE II 
RELIGION AND MANIC-DEPRESSIVE INSANITY 


N the science of psychiatry there is still 
much that is far from clear, and only 
halting attempts have yet been made to- 
wards the formation of a true psychiatric 
system; but there are nevertheless certain 
groups of mental diseases which stand out 
apart from the rest, and it is to the credit 
of our age that these have been charted 
and their limits defined. Among these 
forms of mental disease is the manic- 
depressive psychosis. Dr. Krepelin, of 
Munich, the leading mental specialist of 
our day, described this disease some twenty- 
five years ago, and separated it from the 
other psychoses. 
I shall now endeavor to give some idea 
of this manic-depressive psychosis, and in- 


[42] 


Manic-Depressive Insanity 


dicate, by examples, the social and reli- 
gious significance of this disease. In or- 
der to do so, however, I must first of all 
describe that element in it which, as the 
name implies, amounts to one half of the 
whole, that is, mania, a disease which occu- 
pies the same position, compared with de- 
pression, as does light to darkness or joy 
to sorrow. 

All of you, no doubt, have met with peo- 
ple who for certain periods, or throughout 
a great part of their lives, were remarkably 
lively and full of vitality, while at other 
times they were dull and reserved; people, 
that is to say, who are subject to varying 
moods; people who can go about for a long 
time heavy and sad, mournful and re- 
strained, unable to enjoy life as their fel- 
lows do, and then suddenly light up into 
liveliness; they are cheerful and happy, 
full of energy, and with a capacity for 
work in marked contrast to their former 
pace. They can laugh and talk, sing and 
whistle, and work from morning to night; 


[43] 


Morbid Mental States 


and in this exalted state of vitality they 
can overcome difficulties, carry out tasks 
which would have been beyond their power 
in the periods of depression. They may 
achieve results of the greatest importance 
to themselves and other people. It is a 
well-known fact that many artists and men 
of genius are of this type, only working 
intensively, only creating anything of 
importance, during their periods of exalta- 
tion. Not a few of our greatest master- 
pieces in the sphere of art—literature, 
music, and painting—owe their existence 
to this high pressure in the mental state, to 
an exaltation which even the artist himself 
realizes is half pathological. It is no ex- 
aggeration to say that these periods rep- 
resent, to a certain extent, the flourishing 
period of life, in so far as many of the most 
beautiful products of the human mind 
were created in such periods. And in the 
field of religious life also, the sunshine of 
exaltation has brought forth many splen- 
did blooms—ecstasies, revelations, experi- 


[44] 


Manic-De pressive Insanity 


ence of blessedness, and many another sud- 
den and partly incomprehensible develop- 
ment have taken place in such periods of 
exaltation, and more particularly during 
their initial stage; that is, at the sudden 
transition of the mind from the state of 
depression to that of exaltation. 

Let us now imagine that the exaltation 
increases in force and at last passes the 
bounds of what we ordinarily regard as 
normal. We then have mania. Mania is 
thus the exact reverse of melancholia, its 
opposite in every respect. Patients suf- 
fermg from melancholia are sad; those 
suffering from mania are glad and boister- 
ous; in melancholia they are hampered in 
speech and can hardly utter a_ word, 
whereas in mania they talk extravagantly, 
and their association of ideas takes place 
with abnormal liveliness. In melancholia 
they are mentally at a standstill, whereas 
in mania they are mentally excited and 
productive to the highest degree. They 
talk and sing, laugh and whistle, preach 


[45] 


Morbid Mental States 





and write, work without pause or rest, in- 
terfere with everything around them, make 
plans of all sorts, forget to take their 
meals, and have no time to sleep. And as 
long as they are able, they throw money 
about lavishly, their own and other peo- 
ple’s; it is often this which leads to their 
being shut up in an asylum.’ 

Now it is characteristic—and a point 
worth noting—that this morbid exaltation, 
or mania, in its slighter forms is far less 
easy to diagnose, or recognize, for the lay- 
man, as a state of disease, than depression 
or melancholy. ‘This is a thing we mental 
specialists have found again and again; 
and there is, after all, nothing remarkable 

1It may here be well to point out that the ques- 
tion whether a person should be “shut up” in an 
asylum or not is generally decided more from social 
than medical motives. It is only when a person be- 
comes a social danger in one way or another, as, 
for instance, by threats of violence, extravagance 
with money, plans for suicide, or the like, that he 
is placed in a hospital or nursing home. This is 
often a great mistake, since by taking such meas- 


ures at an earlier stage, the disease might have been 
checked, or some disaster averted. 


[46] 


Manic-Depressive Insanity 


in that it should be so. It is harder to see 
that a person is ill when he is cheerful and 
full of energy and joy in life, than when he 
sits about listless and mournful, incapable 
of doing anything. And so it is that a 
number of people go about in a high state 
of exaltation, sometimes even with a slight 
—but harmless—mania, simply because 
their condition is less “‘asocial’ than the 
depressive state. They are more capable 
of work, and easier to get on with. But in 
both cases it is really a matter of actual 
and well-defined mental disturbance. 
When patients of this sort are admitted 
to hospital, we find them, as a rule, imme- 
diately after in the restless ward, where 
they run about the room more or less com- 
pletely dressed and talking unceasingly. 
Their tongues are never still. They talk 
of a dozen things at once—of themselves 
and their friends, events in their own lives 
and those of others, politics and economics, 
life and death, God and the devil. Of- 


ten their observations are keen, striking, 


[47] 


Morbid Mental States 


marked by a certain humor and an in- 
creased acumen. If they find anything 
wrong with the doctors or nurses, a but- 
ton missing from an overall, or a few min- 
utes delay in going the rounds, they are 
sure to let us know it. Maniac patients 
are reformers par excellence. They are 
the judges of the institution. 
Simultaneously with this abnormal men- 
tal activity we find another easily recog- 
nizable symptom in the feeling of exalta- 
tion which induces the patients to see 
everything couleur de rose—the past, the 
future, and themselves. The maniac is al- 
together lacking in self-criticism, and in 
this respect, also, mania is the exact op- 
posite of melancholia. The maniac over- 
estimates himself, he is self-sufficient and 
pompous, and may at times also have ac- 
tual ideas of greatness, as, for instance, 
that he is very rich, rarely accomplished, 
a person of distinction, and the like. 
These ideas are, however, transient and 
changing; not, as in the case of crazy 


[48] 


Manic-De pressive Insanity 





(paranoia) patients, fixed and unalterable. 
Sufferers from mania may at times also 
have hallucinations, as do the melancholia 
patients, but they are as a rule of a pleas- 
anter character. They have _ beautiful 
dreams and blissful experiences, in marked 
contrast to the gloomy and painful hal- 
lucinations of melancholia cases. 

And now, what about exaltation and 
mania in the subsequent course of the dis- 
ease? Can these patients recover, or are 
they incurable? How long does the 
trouble last? 

Mania, like melancholia, is a curable dis- 
ease, and patients can make a complete re- 
covery, with no mental defect whatever re- 
maining—that is, in cases of mania proper. 
But it may be a long time before they get 
well; months and years, in some cases sev- 
eral years, may pass before they are cured. 
There are two things in particular which 
make matters difficult for these patients, 
and we must consider these a little. 

In the first place, mania and melancholia 


[19] 


Morbid Mental States 





have a tendency to pass over from one into 
the other, so that a patient after having 
been in a state of exaltation, becomes de- 
pressed, or, after depression, gets into a 
state of exaltation. It may happen that a 
patient who has lain weeping and moaning 
in bed for a long time suddenly appears 
smiling and cheerful, and, in answer to 
the question as to how he feels, replies, 
“First rate; never felt so well in my 
life.” Or a patient who has been running 
about all day shouting and singing and 
making a noise may in the course of a few 
hours fall into a depth of depression and 
refuse to utter a word. He now feels him- 
self the most miserable creature on earth. 
This change of mood from mania to mel- 
ancholia may be repeated several times; 
and when this takes place, we have the dis- 
ease I mentioned before—manic-depressive 
psychosis. 

Manic-depressive psychosis has a tend- 
ency to attack a person several times dur- 
ing a lifetime, and this is the second dif- 


[50] 


Manic-Depressive Insanity 


ficulty in the case of such patients. They 
always recover from a single attack and 
are then completely well, but the attack 
may recur; it may come again and again 
in the same form or in its opposite; indeed, 
we may have mania and melancholia alter- 
nating in the same person throughout a 
period of several years, and when this oc- 
curs regularly at brief intervals, we call 
it “folie circulaire,” that is to say, a men- 
tal disease in which the two phases, mania 
and melancholia, are constantly alternat- 
ing, the patient being only completely well 
for short periods between. The mental 
state shows a series of undulations; these 
patients are always too exalted or too de- 
pressed; only where the wave-line, so to 
speak, intersects the normal level is there 
a brief period of normal sanity. 

After these general observations on ma- 
nia and the manic-depressive psychosis, I 
will now give some instances of mania ac- 
companied by religious ideas. I should 
like to point out, however, that while re- 


[51] 


Morbid Mental States 


ligious ideas and experiences in patients 
afflicted with melancholia are as a rule of 
a gloomy, unpleasant, and painful char- 
acter (self-reproach, sense of guilt, and 
the conviction of being eternally lost), 
those of persons suffering from mania are 
chiefly pleasant and agreeable, expansive 
in their nature. This is, indeed, only in 
accordance with the nature of the respec- 
tive diseases and the mood associated there- 
with. 


CasrE 6.—This was a carpenter, aged 
forty, who had hitherto been always 
healthy and steady. Like so many other 
mechanics, he was, as a rule, cheerful 
enough, drank a little when he had the 
money, took no interest in religious mat- 
ters, and never attended church. 

The disease began with a pronounced in- 
terest in politics and religion. He tock to 
going to meetings of a religious or social 
character. He wanted to reform society 
and start a revolution. He drew up a 


[52] 


Manic-Depressive Insanity 


proclamation to his fellow-citizens, invit- 
ing them to march to the palace of Am- 
alienborg and “take away the king’s 
crown.” ‘To the astonishment of his fam- 
ily, he began reading the Bible, and de- 
clared that he would henceforth believe in 
Jesus and follow His example. The Bible, 
he said, was a splendid book, and he had 
been given insight into all its details; he 
must therefore go out and convert his 
fellow-men. Accordingly, he took to mak- 
ing speeches in the streets about his mis- 
sion; he was convinced that he had been 
chosen to spread abroad the message of 
Christ. He talked day and night of his 
ideas and plans, ate nothing and slept but 
little, but was in the best of spirits, whis- 
tled and sang, preached and wrote inces- 
santly. The other members of the family 
got no peace; and when at last he began to 
have hallucinations, hearing voices and see- 
ing visions, he was sent to Section VI. 
While in hospital he presented the ap- 
pearance of a typical mania case, with 


[53] 


Morbid Mental States 


quick flight of thought and mental and 
physical unrest. He made long speeches 
about religious and social questions, drew 
up proclamations to the people, to the 
king, to the parliament; he wanted to get 
bread for the poor and destroy the rich, to 
preach the gospel of Christ, and ring the 
bells of peace, to be crucified himself with 
Christ. 

The following is a specimen of his talk: 
“T think of life; life is a mystery; the 
workers suffer and toil for bread, for life. 
I think of those who lie swimming in blood. 
It hurts me to think there is war going on 
in the world. I have traveled in foreign 
parts myself. I’ve seen a deal of misery. 
When I was in Germany, I got the ‘Social- 
Democrat?” (a newspaper) “and it said 
‘Sol’ ” (the word in Danish means “‘sun’’) 
“‘and when I came home it said ‘Sol’ again, 
and that means ‘Solidarity.’ And I have 
been to church too. I got three papers 
there; but I put my trust in Pastor Thom- 
sen out at Vesterbro, for I’m going to live 


[54] 


Manic-De pressive Insanity 





my own life; and the Lord has forgiven 
my sins; and we’re all to be good Chris- 
tians |!” 

This patient was for some time so rest- 
less that he had to be kept in a warm bath 
and was given strong soporifics. After 
that, he gradually quieted down. He 
ceased to talk so much, and the religious 
obsession grew less marked, so that in 
about six months he was well again. He 
became once more a cheerful, steady car- 
penter, with a touch of swagger, but devoid 
of social or religious interests. He had 
but slight recollection of things that oc- 
curred during the period of his illness. 


Cast 7.—This was a man of twenty- 
eight, previously healthy and intelligent, 
industrious, natural, and sociable. In the 
autumn of 1917 he began writing letters 
to his brother, in which he expressed dis- 
satisfaction with his position, criticized his 
fellows, and used various religious phrases. 
On November 23 he came to visit his 


[55] 


Morbid Mental States 





brother in Copenhagen with a view to 
“converting the whole city.” The devil 
had been after him, but now he was saved, 
and would save others; he was very restless 
and fidgety, talked a lot, and ran about the 
streets, so it was thought best to have him 
placed in a hospital. Here he was very 
excitable, and tried at once to convert the 
patients and porters by driving the devil 
out of them. A letter to his relatives ran 
as follows: 


Dear BRETHREN AND SISTERS IN THE Lorp: 
When you see these first words you will doubt- 
less think I’m thoroughly dotty, but I assure 
you I’ve never been so happy as I am now. 
But you, dear friends, will no doubt soon have 
discovered what’s happened to me. You 
know that Jesus Christ our Lord has said that 
he that is not with me, the same is against me, 
and you can’t say you were with me at first the 
last time I came to see you, but you did turn 
after a bit to seek the kingdom of the Lord. 
Remember that sermon of Pastor A. Hansen, 
about crossing the boundary line, and think of 
St. Paul and finishing the course. I dare say 


[56] 


Manic-De pressive Insanity 





you are afraid of working too hard, and losing 
a little unnecessary fat—what, you two? But 
never mind about that; let us turn to serious 
things. I came over to Copenhagen just be- 
fore New Year, and am still in Section VI— 
CLO CLC. 


The patient was removed to an asylum, 
where I had a conversation with him one 
day. It was more or less as follows: 
“Do you believe in God?”—“Yes, the 
Almighty God He guides our will. It’s 
done by hypnotism, but sometimes they do 
it by God’s word.”—“‘Have you been con- 
verted then?”—“Yes, it was in Septem- 
ber, and I was ever so glad of it, for I 
understood everything then, and knew I 
was saved.”—“Why were you so glad?”— 
‘“‘Because my brother sent me a book that 
meant a great deal to me, and I understood 
things then—it ’s all a question of under- 
standing, you know.”—‘“‘Were you un- 
happy before?”—‘‘Yes, all through the 
summer I was terribly unhappy, and I ’d 
done so much that was wrong, and I felt 


[57] 


Morbid Mental States 





the burden of it all.”—‘‘Used you to be 
interested in religion?”—“I always went 
to church, but I never got the real under- 
standing, and it’s understanding that’s 
the thing.”—‘“‘Did you formerly suffer 
from low spirits?” —“Yes, I ’ve always been 
reserved and different from the others, and 
when I was a child, they said I was slow to 
learn.” 
One day he wrote the following letter: 


Dear UNcLE anp Retatives: It is the will 
of the Almighty God that I am to go out! 
Say the word, Lord, and we will cast out our 
nets. And I too want to be of some use in the 
work for the kingdom of God, being sick and 
tired of slaving under the power of death and 
the devil and my own lust of the flesh. It’s 
only about four months back I had to go down 
on my knees to the Savior of the world... . 
And praise be to the Lord, I chose the place 
that becomes a sinner and declared, like David, 
that I could do nothing of myself, but with 
God’s help it is possible to live a holy life. 
When the spirit of God bears witness with my 
spirit that I am a child of God, then a man has 


[58] 


Manic-De pressive Insanity 


a chance. We find it heaps of times, both in 
the Old Testament and in the New, that God 
can shape a creature to His work, which is not 
to be made cease. And when He hasn’t any 
human creatures, He sends angels, as He did 
to the Virgin Mary, for instance. Our Lord 
Jesus came unto His own, but they would have 
none of Him, and it’s the same with those that 
would bear witness to Him that has paid for all 
sinners. If the Old Adam in us, as M. Luther 
says, isn’t thrust aside as a trifle not alto- 
gether needful to life, seeing life here is short, 
but eternity long, God loved us before the foun- 
dations of the world were laid, and our little 
understanding comes to a standstill, which is 
a good thing for us, to find ourselves so small, 
no bigger than a grain of mustard-seed.... 
Now I will try to conclude, but only say I came 
to Copenhagen between Christmas and New 
Year, but the same evening. they took me to 
the hospital to be under observation With 


much love from yours, 
X. 


This patient, in addition to a lively flow 
of imagination and of talk, exhibited for 
some time repugnance to food, declaring 


[59] 


Morbid Mental States 





that now he was “converted” he had no 
need of food. He also urinated in bed “‘to 
make a fool of the devil.” He slept badly, 
and there were periods when he did not 
recognize his surroundings, was often 
violent toward the attendants, became 
greatly emaciated, etc. 

The exaltation lasted about six months, 
after which the patient’s mind gradually 
cleared, and he passed from the state of 
exaltation to a period of marked depres- 
sion (such as had evidently preceded the 
outbreak of the disease, vide his utterances 
above quoted). After that, he slowly 
returned, in the course of a year, to his 
normal condition, and was discharged sane. 


It will be seen, then, that the experiences 
of a patient suffering from mania are 
marked by the exalted mood, and the 
religious ideas which dominate them are 
pleasurable and lofty in tone. It is the 
mental expansion which the patient ex- 
periences, the religious revelation, the com- 

[60] 


Manic-Depressive Insanity 





plete regeneration, the inner spiritual 
deliverance. They dress up, as it were, 
the mood of exaltation—due to psychosis 
—in a religious garment. As long as they 
are under the psychosis, it seems to them 
that they are passing through a valuable 
experience, a true spiritual acquisition. 
But later, when their mind grows calmer, 
these experiences generally lose their splen- 
dor more or less, and sometimes completely. 
It may happen that the patient afterward 
thinks of them with the greatest displeas- 
ure, feels ashamed of his behavior, and will 
not on any account refer to what has 
passed. 

But it is of the greatest importance that 
these religious crises in a state of mania 
should not be taken by priest or layman 
for more than they really are. We have 
here simply a morbid outburst of feeling, 
a pathological state of mind, and though 
there may be some element of truth in them 
at times, they are nevertheless often of 
doubtful religious value, and should al- 


[61] 


Morbid Mental States 


ways be regarded with the greatest scepti- 
cism. 

It is strange, too, that “religious mania” 
should not infrequently occur in persons 
who were formerly irreligious, and who, 
when the mental disturbance has passed, 
entirely relinquish all religious interest. 
This is a proof of the wide diffusion of 
religious ideas, but at the same time it 
shows how superficial and morbid such re- 
ligious experiences can be. 

If I had to cite a field in which the priest 
is particularly liable to be misled, and 
where, too, even the practised psychiatrist 
may find it difficult to determine what is 
genuine and what is the reverse, it would 
be the cases of sudden conversion which 
occur among young people who have for 
some time previously been depressed and 
self-reproachful and conscious of sin. 

The position is this: It is a psychiatric 
law that depression is followed by exalta- 
tion, or that melancholia turns to mania, 
as I have before described. Now when 


[62] 


Manic-De pressive Insanity 


a person has been for some time in a state 
of religious depression, with self-reproach 
and anxiety, and then suddenly changes 
over completely,—possibly after much 
prayer and the intercession of others,—it 
may easily appear to himself and others 
that a spiritual experience of religious 
value has taken place, a conversion, whereas 
perhaps it may be nothing but one of the 
ordinary fluctuations of the mental state, 
having nothing whatever to do with a real 
and profound recognition of the truth, still 
less any intervention from above. The re- 
sults will often prove this subsequently. 
Nevertheless, we are on difficult ground 
here, and it behooves us to move warily. 
For though it be true that the germ of 
truth is rarely to be found in fully devel- 
oped mania or melancholy, and that manic- 
depressive fluctuations as such, do not in- 
dicate any divine intervention but peculi- 
arities in the human mind, it is neverthe- 
less impossible theoretically to deny that 
the psychosis, like all other mental crises, 


[63] 


Morbid Mental States 


may carry with it religious values of 
the highest importance. The theologians 
may rightly declare that God can make 
use of very peculiar, and, from a medical 
point of view, morbid mental states, in or- 
der to bring about certain results in a hu- 
man being. He can, perhaps, in the 
course of a psychosis, teach a person some- 
thing which that person would never oth- 
erwise have learned or understood. And 
there is really no contradiction in putting 
the matter thus. There is nothing incon- 
sistent in saying that what is experienced 
in the course of a psychosis may at times 
be so strange and incomprehensible that 
its deepest value, ethically and religiously 
speaking, is altogether unknown to us. 
We physicians diagnose the case as one of 
insanity, and we are right in doing so, in- 
asmuch as it is undoubtedly insanity from 
the medical point of view. But why 
should not insanity also serve a higher pur- 
pose? Why should there not happen, 
during psychosis, things beyond human 
[64] 


Manic-Depressive Insanity 





understanding, which lead us upward? 
Many persons will stand forth and bear 
witness that such things do happen;' that 
they themselves, at the time of their reli- 
gious awakening, were undoubtedly in- 
sane; they heard voices, and saw visions, 
suffered from insomnia, terror, depression 
or exaltation—yet their awakening was 
real enough. The history of religion 
shows us examples of this; and a simple 
examination of the fervently religious 
among our fellow-men will show us the 
same thing. 

We can, then, only utter a word of warn- 
ing to our friends among the clergy; we 
cannot undertake to make clear the precise 
position in individual cases. We can show 
proof in black and white that the majority 
of psychoses certainly make human beings 
neither better nor richer. But we cannot 
declare that psychosis should not do so in 
certain cases. And undoubtedly there is 
a chance in this respect as regards manic- 
depressive psychosis. 


[65] 


Morbid Mental States 





And here, in conclusion, I would refer to 
some historical instances of manic-depres- 
sive mental disturbance, showing in the 
first place how frequently it may occur 
among persons of great spiritual gifts, 
and, secondly, how the intellectual activity 
of such persons may actually be developed 
and advanced by such mental suffering. 

Grundtvig, the founder of the Danish 
high-school movement, and a prominent re- 
ligious writer and reformer in the first half 
of the nineteenth century, came of a family 
predisposed to insanity; his own case has 
been described in a book by Dr. H. Hel- 
weg, from which the following is mainly 
taken. The first manic-depressive symp- 
toms occurred in 1808-11, when he was liv- 
ing in a state of extreme mental tension, as 
is evident from his writings and sermons. 
This period of forced activity, which would 
be psychiatrically described as a slight 
touch of mania verging on the patholog- 
ical, was succeeded in 1810 by a remarkable 
apathy. He lost his capacity for work, 


[66] 


Manic-Depressive Insanity 


his brilliance and readiness in debate, and 
from his writings it is evident that his brain 
was working heavily and under difficulty ; 
his mind is occupied mainly with the darker 
side of life, and some of his poems from 
this period seem to give warning of the 
outbreak which was to come—the first at- 
tack of insanity. In December, 1810, his 
health broke down. One morning he was 
obliged to remain in bed, and the doctor 
summoned declared that the patient was 
not suffermg from any physical disease, 
but “struggling inwardly for his soul’s 
salvation.” Grundtvig is now restless and 
depressed. His friends find it difficult to 
keep him under control, and he speaks of 
“feeling the devil bodily, twining round him 
like a serpent.” Whether he actually had 
hallucinations it is difficult now to deter- 
mine; it may perhaps have been a case of 
fanciful imagery. He was, at any rate, 
strongly obsessed by the idea of sin, and 
in one of his poems he recalls how he felt 
that the Lord had condemned him to worse 


[67] 


Morbid Mental States 


than the grave; how he perceived Death 
in a ghostly form and shuddered at him- 
self. | 

A period of quiet and rest in his home at 
Udby somewhat restored him, but on his 
return to Copenhagen he had again, after 
the preliminary period of melancholia, a 
new attack of mania, in the course of which 
he exhibited a violent degree of activity and 
wrote some remarkable poems. 

In later life Grundtvig had three further 
attacks of manic-depressive psychosis. 

One was in 1844, when a phase of mania 
followed on the production of some writ- 
ings in which the pathological element is 
distinctly marked; a melancholy phase suc- 
ceeded this, and the patient was now him- 
self aware that he was ill. The second 
attack came in his seventieth year, in the 
form of a brief, but profound, depression ; 
the last was in 1867, when he was nearing 
eighty-three; on this occasion the attack 
took place in church, and Grundtvig sud- 
denly invited the congregation to take the 


[68] 


Manic-De pressive Insanity 





Sacrament, and addressed the queen dow- 
ager as “The Queen of the South, come to 
hear the wisdom of Solomon,” adding, ‘‘and 
a greater than Solomon is here.” During 
the period which followed, Grundtvig was 
acknowledged to be insane, and treated as 
such. 

Besides these attacks, there were other 
minor fluctuations in his mental state 
throughout his long life, which showed 
through in his literary production. Al- 
together, the life of Grundtvig is a strik- 
ing instance of the manner in which the 
manic-depressive constitution can affect a 
man’s personality and his work, without 
being recognized by those about him as 
a positively pathological condition. The 
important point to note is, that Grundtvig, 
throughout these attacks of insanity, espe- 
cially the first, undergoes a religious devel- 
opment and fights his way to fresh points 
of view and experience of life which proved 
of the greatest importance to his later life 
and work. The psychosis, that is to say, 


[69] 


Morbid Mental States 





seems in a way to have furthered his spirit- 
ual development. 

The Danish philosopher, Séren Kierke- 
gaard, who was also an intensely religious 
character, exhibited in the course of his life 
mental aberrations of a similar nature to 
those of Grundtvig, albeit less pronounced. 
His depression on the breaking off of his 
engagement as a young man, some curi- 
ously erratic writings at a later stage, and 
the state of his mind before his death, to- 
gether with the family disposition, which 
weighed on him greatly,—his father’s mel- 
ancholy, and his brother’s insanity,—all 
these points might seem to suggest (I do 
not venture to say more) that Sgren Kier- 
kegaard also is an instance of manic- 
depressive constitution. 

Another Danish religious writer, Wil- 
helm Birkedal, suffered for many years 
from a disability which must doubtless be 
regarded as the result of mental depression. 
He tells in one of his poems how he had to 
struggle during this period, when he 


[70] 


Manic-Depressive Insanity 


stepped into the pulpit, a man sick nigh 
unto death; how for sixteen years he had to 
fight against a burning drought of the 
spirit that threatened to wither up his soul, 
and strove to believe in God as a God of 
love, not of wrath. And with this struggle 
and its ultimate effects in mind, he tells us 
in another poem how he attained to har- 
mony and reconciliation. 

It is thus that depression and mania re- 
veal themselves in the lives of great per- 
sonalities. And in the lives of lesser men 
we find the same fluctuation, the same wave 
movement, less known to the world, but of 
no less importance to the individual him- 
self. 

And yet, widespread though the manic- 
depressive disposition may be, it does seem 
as if it were particularly frequent among 
men of distinctive character and ability. V 
It seems as if it somehow aided them to be- 
come what they are. And in so far as the 
depth and importance of a personality 
depend on its power of feeling deeply and 


[71] 


Morbid Mental States 





living strongly, sounding the great depths 
of existence and answering to the great 
spiritual movements of the times—to this 
extent, at least, the manic-depressive con- 
stitution gives its possessor an advantage 
over the level-headed, more superficial na- 
tures, ignorant alike of the extremes of 
light and darkness. 

Just as a storm may fling the waters of 
the ocean into turmoil and bring up to the 
surface things otherwise hidden in the 
depths, so also the manic-depressive psy- 
chosis may create a turmoil in the human 
mind and bring forth what les hidden 
there. There are many Christian person- 
alities who, in the depressive periods of 
their lives, have undergone religious crises 
which they would not be without, and have, 
in their periods of exaltation, spoken or 
written of those religious experiences to 
the benefit of their fellows. 


[72] 


LECTURE III 


RELIGION AND INCURABLE FORMS OF 
INSANITY 


F it be true that any physical disease is 

a burden laid upon a human being, and 

a trial which none would willingly be called 
upon to endure, it is even more true of 
mental suffering. These diseases are an 
evil which no human being desires, a pain 
which all would prefer to avoid, for they 
touch in most distressing fashion the in- 
nermost core of our personality. A broken 
leg or faulty digestion or a tuberculous 
lung may be bad enough; but one can still 
to a certain degree adopt an objective at- 
titude towards the phenomenon, and live 
one’s spiritual life in spite of it. But men- 
tal disturbance touches us at the center. 
It affects our innermost ego and trans- 


[73] 


Morbid Mental States 


forms our personality. And herein lies 
its sting. 

But if this may be said of curable forms 
of insanity, how much more so of those 
which are incurable? Such diseases bring 
us face to face not only with burdens to be 
borne, but with mysteries to be solved, and 
which hitherto no human being has been 
able to solve. The problems here put be- 
fore us are among the greatest which the 
mind of man has had to deal with. Thou- 
sands of human beings have in the course 
of centuries been affected by incurable 
forms of insanity; and thousands have, by 
the mystery of these diseases, been led to 
doubt the meaning of existence and the 
loving-kindness of God. 

And now, why should those about to be 
ordained know something of incurable men- 
tal diseases? 

The first reason is simple enough, aris- 
ing out of what has just been said, namely, 
that the clergy must take up their posi- 
tion and determine how they stand in re- 

[74] 


Religion and Incurable Insanity 


gard to the problem of insanity ; they must 
face the mystery of mental disease. When 
a priest commences work in his parish, he 
will encounter a number of persons whose 
near relatives are seriously insane, and he 
must be able to help these persons. And — 
he can only do so if he has had an op- 
portunity of determining for himself what 
can be the place of mental disease in the 
plan of our existence, to make up his own 
mind as to how the problem of insanity 
can be reconciled with the belief in the 
goodness of God. He who is to act as a 
guide to others must himself have some 
guidance in regard to the great problems 
of existence and the sufferings of human 
life. “My husband has lost his reason,” 
a woman will say, ‘‘and that has led me 
to doubt the goodness of God.” “My 
daughter is mentally defective,” a man will 
say; “she behaves like a brute beast, and 
that has made me hate God.” ‘“My son 
has epileptic fits,” a third will say, “and it 
makes him wicked; how am I to make this 


[75] 


Morbid Mental States 





agree with the belief in free will?” Hun- 
dreds of questions will in course of time 
present themselves to the spiritual adviser, 
and he has to find an answer. He must in 
each case find some advice to give these 
doubting souls; he cannot leave them de- 
spairing or defiant. 

But the priest must know something of 
these mental diseases, not only for the sake 
of the relatives of the afflicted, but also for 
the sake of the sufferers themselves. Per- 
sons suffering from mental disease will, in 
the early stages, themselves seek the advice 
and guidance of a priest. For it is a mat- 
ter of experience that in cases of mental 
suffering, people turn first of all to those 
whom they have been accustomed to regard 
as their spiritual guides, namely, the priest 
and the teacher. How many insane per- 
sons have not at one time or another sat in 
their pastor’s study and poured out their 
woes? How often has not the priest him- 
self had to visit these doubting and trou- 
bled, miserable and despairing souls? But 


[76] 


Religion and Incurable Insanity 


among these there will from time to time 
be many in the initial stages of insanity, 
and it is of far-reaching importance that 
the priest should here be able to render 
first aid, and refer the sufferer to a doctor 
when the case lies beyond his own power to 
deal with. 

We shall now consider two groups of in- 
curable insanity, namely, chronic paranoia 
and dementia precox. 

Paranoia is a disease which attacks ex- 
clusively, or at any rate mainly, the in- 
tellectual side of human _ consciousness. 
If we divide consciousness, according to the 
old principle, into three parts, namely, 
idea, feeling, and will, it is here the sphere 
of ideas that suffers. The patients have 
what are called fixed ideas, a craze or 
crotchet of some sort. They imagine, for 
instance, that they are subjected to per- 
secution, or that they are something par- 
ticularly great, or have invented perpetual 
motion, or the like. One thinks he is the 
Duke of Cumberland, or the Emperor of 


[77] 


Morbid Mental States 


Brazil, a new Messiah, or the Lord Al- 
mighty, and so on. But apart from this, 
and in all other respects, they are as a rule 
quite normal. They talk and think, act 
and feel exactly as the rest of us do, and it 
is only when we touch on this one point, 
their fixed idea, that they are obstinate; 
there is nothing to be done with them here; 
they are simply crazy. 

The disease may take different forms ac- 
cording to the nature and character of 
the ideas involved. The most common 
form is the idea of persecution. This be- 
gins when a person who has previously 
been frank and cheerful suddenly becomes 
reserved and suspicious, shy and unsoci- 
able. He thinks other people are strange 
in their manner toward him and trying to 
do him harm. People look at him in the 
street, his neighbors lay their heads to- 
gether and whisper when he passes by. 
Spies are set to watch him, and dark ref- 
erences are made to him in speech. News- 
paper articles refer to him between the 


[78] 


Religion and Incurable Insanity 


lines; policemen make signs to each other 
about him. There is something funny, 
too, about the food—some one must be try- 
ing to poison him. Urged now by terror, 
he goes to the police. The matter is in- 
vestigated, and nothing is found to war- 
rant any suspicion; for a time, perhaps, 
the sufferer calms down. But the per- 
secution commences anew. He finds in the 
most ordinary happenings proof that 
somebody is “after” him, and he goes to 
the police again, but is turned away. In- 
censed at this, he shuts himself up in his 
rooms, barricades the doors and seals up 
the windows, and settles down with a store 
of provisions to await his fate. 

When patients of this sort are admitted 
to hospital, they are at first greatly re- 
lieved to find themselves beyond the reach 
of their imaginary persecutors. But soon 
the “plot” begins to show itself within the 
walls of the asylum. Doctors and nurses 
are taking the part of the enemy. Here, 
too, they put poison in the food and try to 


[79] 


Morbid Mental States 





incense the other patients against the un- 
fortunate victim. In a word, the suffer- 
ers are surrounded by a mesh of intrigue 
from which there is no escape; they see on 
every side enemies lying in wait to com- 
pass their destruction. As a result, they 
soon become taciturn and bitter, unap- 
proachable, and full of hatred to all about 
them; they sit scowling in a corner or hud- 
dled up in bed, often with fingers in their 
ears to keep out the “‘voices” that cry out 
threats and abuse through the walls and 
ceiling. 

If the disease advances further, we often 
find a remarkable transformation in the 
patient’s ideas, in that the idea of persecu- 
tion gives way to megalomania, the idea 
of greatness. There is a logical explana- 
tion of this in the fact that when patients 
find themselves persecuted on every side, 
they can only consider it as due to their 
being in some way great or remarkable. 
For it is only famous people who are per- 
secuted in this fashion; or else there must 


[80] 


Religion and Incurable Insanity 





be something of particular value in their 
possession. ‘They fancy, then, that they 
are lords and ladies, princes or princesses 
wrongfully suppressed, heirs to great for- 
tunes, the emperor, the pope, the Messiah, 
or God himself. At St. Hans, the munici- 
pal asylum at Copenhagen, we had no 
fewer than five patients each believing him- 
self to be God. 

This, however, is not the form of par- 
anoia which interests us most in a religious 
respect. The religious fixed ideas in cases 
of paranoia major are so massive and ex- 
travagant that no priest could mistake 
them or treat them as normal. But it is 
otherwise in cases of paranoia minor, where 
the ideas can be really deceptive, and we 
will therefore consider them a little more 
closely. 

There is first of all the querulous form 
of paranoia, in which the patients believe 
they have suffered injustice in some re- 
spect, and are consequently obsessed by 
the idea of obtaining redress and com- 


[81] 


Morbid Mental States 


pensation at any cost. The idea is often 
associated with a legacy, or default in pay- 
ments due, being passed over for promo- 
tion or otherwise neglected; and though 
there may sometimes be a slight actual in- 
justice in fact at the back of it, the results, 
as far as the patient is concerned, are al- 
together pathological. The affair leads 
to great lawsuits, with arguments pro et 
contra, examination of witnesses, and docu- 
ments by the ream. ‘There are embittered 
discussions in public and private, in writ- 
ing and by word of mouth; and through- 
out all this, the patients have no rest day 
or night. The affair is always in their 
mind, and they can think of nothing else. 
If the decision goes against them,—as is 
naturally often the case,—they resort to 
writing to the papers, publishing pam- 
phlets and booklets, advertisements and 
placards in the streets. When all this 
proves of no avail, they take the matter 
into their own hands, force their way into 
some Government office and make a scene 


[82] 


Religion and Incurable Insanity 


there, or box the ears of a distinguished 
official—as happened once in Section VI, 
—or threaten to murder the minister of 
justice, as in the case of a patient at St. 
Hans. ‘This form of mental disease, par- 
anoia querulatoria, is naturally of par- 
ticular interest to lawyers. 


Cast 8.—I remember a patient in Sec- 
tion VI, a tailor, who considered he had 
been wronged in a deal over some property, 
and therefore set himself to persecute the 
judge. For several years he kept on send- 
ing him threatening letters and petitions, 
and when this proved fruitless, appealed 
to the courts, where his case was refused a 
hearing. He then took to writing to the 
minister of justice, with applications for 
restitution and complaints. Gaining noth- 
ing by this, he wrote to members of par- 
liament complaining of the ‘“‘plot”’ in which 
courts of justice, ministers, and function- 
aries were united to defraud him of his 
rights. No result from this. He then 


[83] 


Morbid Mental States 


wrote to the king, stating that if he were 
not granted his rights at once, he would 
have recourse to “action”—which he ex- 
plained as meaning that he “had unfor- 
tunately no alternative but to shoot at the 
police.’ The patient was arrested, and 
kept for several years at St. Hans, where 
he exhibited all the symptoms of paranoia 
querulatoria. 


Another form which this disease may as- 
sume, and which may, perhaps, be of more 
interest to clergymen, is the erotic paran- 
ola, or erotomania. The course of this 
may be as follows: A lady falls in love with 
some well-known personage, priest, doctor, 
actor, or the like, and feels convinced in 
her own mind that her affection is returned. 
She thinks the man looks at her when they 
meet in the street, the actor nods to her 
from the stage, the priest makes references 
to her in his sermon. There can be no 
doubt but that the man in question is fond 
of her, and she finds confirmation of the 


[84] 


Religion and Incurable Insamnty 


fact in a thousand trifles. When she reads 
the newspapers, for instance, she can read 
between the lines that he is sending her 
a message. When she finds a _ flower 
dropped in the street, it is one he has 
placed there for her. When she receives 
a letter, it is his writing on the envelop, 
etc. As a result of these imaginary ad- 
vances on the part of the other, she does 
the like in return, sending her admirer end- 
less letters and presents, flowers and sofa 
cushions and so on. And when this has 
gone on for some time, she takes the de- 
cisive step and makes her confession. 
Strangely enough, he will have nothing to 
do with her. She tries again, with the 
same result. And from this point on- 
ward the poor creature becomes a positive 
plague to her innocent victim. She fol- 
lows at his heels day and night, bombards 
him with notes and love-letters, and in the 
end the man is obliged in self-defense to 
appeal to the police, when the patient is 
generally sent to Section VI. 
[85] 


Morbid Mental States 


CasE 9.—A young girl imagined her 
schoolmaster was in love with her, declar- 
ing his affection in a variety of curious 
ways. He looked at her “strangely” dur- 
ing lessons, and everything he said had a 
hidden meaning. At an examination, for 
instance, he said to her, ‘Well, now, let ’s 
see if we can manage this”—-which was ob- 
viously a declaration of love. Whenever 
he spoke kindly to her it was the same. 
She therefore began writing letters to him, 
in an increasingly affectionate strain, and 
ended with an open offer of marriage. 
She was removed from the school, but con- 
tinued to send him letters and flowers at 
all times, rang him up on the telephone, 
and spent hours waiting on the stairs out- 
side his rooms. After a while she went so 
far as to declare that she was his wife, with 
the result that she was placed in an asylum. 
Here also, however, her obsession persisted 5 
every letter that came for any of the other 
patients was intended for her, every ring 
at the bell meant he had come, and every 


[86] 


Religion and Incurable Insanity 





whisper in the room was a reference to 
her love-affair. At last she got over the 
fence and ran out on the road to meet 
him. 


Though we may say that these poor 
creatures cause themselves more suffering 
than others, they may nevertheless be a 
serious annoyance to other people; not to 
speak of the terrible scandal they can 
create if not taken in time. 

Even more troublesome to society, and 
more interesting from the religious point 
of view, is reformatory or religious par- 
anoia. 

This disease takes the form of patients 
feeling themselves called upon to reform 
society and bring about a new state of 
paradise on earth, or preach a new gospel. 
The sufferers may be persons who have 
previously been peaceably engaged in ag- 
ricultural work, or serving quietly behind 
a counter, but now suddenly discover they 
have a “call” to alter the conditions of 


[87] 


Morbid Mental States 





society. And they leave the plow or the 
shop, accordingly, and set about their so- 
cial or evangelistic task. 


Casr 10.—I have here in mind a decent 
farm laborer who got the idea that he was 
chosen to preach a new gospel communi- 
cated to him by the Spirit. He therefore 
hastened to take a ticket to Copenhagen, 
where he installed himself at a hotel fre- 
quented by farmers and cattle dealers, and 
started preaching at street corners. There 
was nothing particularly dangerous to so- 
ciety in what he said; it consisted really of 
some undigested fragments out of Revela- 
tion, which the poor fellow delivered after 
his own fashion; but his manner and strik- 
ing appearance led the police to take him 
to an asylum. Here he continued to 
preach as before, and in long, endlessly 
circumstantial scribblings set down his | 
ideas for the doctors to read, at the same 
time preaching to any of the patients who 
cared to listen. All this time he was quiet 


[88] 


Religion and Incurable Insanity 





and peaceable, a harmless soul enough, 
able to talk sensibly on many subjects, but 
with no idea that he was really insane, and 
unable to realize that he could not be al- 
lowed to go about preaching as he did. 
Here is a specimen from one of his ser- 
mons: 


I, the prophet of the Lord God, hereby in- 
form the doctors that this is the last time I 
shall apply to them to let me have my clothes 
so I can get away from here. If I don’t get 
the things by this evening, the Lord Zebaoth 
will send a couple of military auditors who will 
take the doctors away to the military lock-up, 
and three days after I shall ask the military 
auditors, at the command of Him who created 
heaven and earth, to have those doctors be- 
headed and executed, for they are blasphemers. 
It is the height of blasphemy and high treason 
that these faithful attendants of the Serpent 
will help their god, the Serpent of the earth, 
to the last breath. Perhaps you may get off 
with being dismissed from your office if you 
let me have my clothes so I can get away from 
here this evening, for all the crimes that have 
been committed against me, seeing I am the 


[89] 


Morbid Mental States 


prophet of the Lord Zebaoth, and with the true 
gospel to preach to mankind on earth. For in 
me is the word of Him that created heaven and 
earth, and hath all things under His command. 
He that hath power and will to let all things 
stand fast according to law. 


Such patients, in the more serious 
stages, are rarely met with outside an asy- 
lum. They are therefore of minor im- 
portance in practical religious respects. 
But the slighter forms of religious para- 
nola are not uncommon, and often lie con- 
cealed among those persons who form new 
sects and congregations of their own, with 
some eccentric interpretation of the Bible. 
Little circles of this sort can do a great 
deal of harm, as, for instance, by turning 
the heads of less intelligent persons. 

There is more danger probably to be 
apprehended from the reformatory para- 
nola. Persons suffering from this form of 
disease may exhibit an astounding energy 
and unparalleled obstinacy in their attacks 
on society, gathering round them, more- 


[90] 


Religion and Incurable Insanity 


over, a host of the discontented and op- 
pressed, such as are to be found in plenty 
in most societies. Anarchists, nihilists, 
bolshevists, and other radical elements 
have among them leaders of this type, and 
in times of crisis or social disturbance, such 
as we have seen recently in Russia, such 
persons will always exhibit marked activity 
and take advantage of the general unrest. 

It must not be forgotten, of course, that 
in these cases, as indeed in psychiatry gen- 
erally, tt is difficult to determine in a given 
wnstance what is normal and what is patho- 
logical. 'There is no sharply defined boun- 
dary line between sane and insane, as there 
is in a mathematical calculation between 
one side and the other, and not infre- 
quently common sense and careful judg- 
ment have to take the place of any positive 
criterion. Moreover, times change, and 
with them the general view of what is nor- 
mal and abnormal; also, as I have already 
mentioned, it is often social rather than 
medical considerations which determine 


[91] 


Morbid Mental States 


whether a person is to be shut up in an asy- 
lum or allowed to go about at will. 

One thing, however, must here be borne 
in mind, and it is of great importance to 
the layman to realize this, namely, that the 
mental specialist does not base his diag- 
nosis on a single symptom, or a single ex- 
travagant idea or feeling, whether reli- 
gious or otherwise. It is not necessarily a 
sign of insanity, for instance, when a per- 
son declares that he has sinned against 
God, or has done a great deal of evil. Nor 
is it necessarily insanity when a man be- 
lieves he has a new gospel to preach, or 
is chosen to reform the world. Great 
minds are naturally very liable to be called 
insane by those who do not understand 
them. Even Jesus of Nazareth was not 
exempt. 

No, the thing that warrants the medical 
man in diagnosing a case as one of in- 
sanity is not a single symptom, but a 
symptom-complex, a group of symptoms 


[92] 


Religion and Incurable Insanity 


in which one is firmly and regularly asso- 
ciated with the next, one supplementing 
the next, in such a manner that experience 
justifies certain definite conclusions and a 
particular prognosis. Psychiatry is no 
longer philosophical, but empirical. So 
that when a man, in addition to self- 
reproach, has the further symptoms of in- 
somnia, hampered mental process, and 
groundless fears, with slight hallucinations, 
we know we have to deal with a particular 
form of disease, namely, melancholia. 
And when a man, in addition to ideas of 
reforming society, also has ideas of perse- 
cution and personal greatness in a certain 
typical combination, when he isolates him- 
self from the world to cultivate his ideas 
in a barren form, does not sleep or eat, and 
has visions and revelations from time to 
time, we know he is insane, he is suffering 
from paranoia. 

I will here conclude with a typical ex- 
ample of religious paranoia. 


[93] 


Morbid Mental States 


Case 11.—At one of our asylums there 
was admitted in 1918 a man stated to have 
been always of peculiar character, with ex- 
treme views and a tendency to follow fan- 
tastic and extravagant schools of thought. 
Even as a child he was dreamy, with keen 
imagination, played by himself for the most 
part, and had few companions. When 
only eighteen he wrote stories and verses 
and occasional newspaper articles. He 
was not interested in religion or church 
matters. 

After having been a free-thinker for 
many years, he began, eighteen months 
previously, to read the Bible, and took to 
speculating day and night on religious 
matters, read American books about the 
millennium, wrote religious articles in the 
papers, and exhibited a charitable activity 
far in excess of his means. His wife and 
children began to suffer want, especially as 
he was now also neglecting his business. 
His wife reproached him for his neglect, 


[94] 


Religion and Incurable Insanity 


but he grew more and more taciturn and 
reserved. 

On July 25, 1917, he suddenly declared 
that he was the prophet Elijah, and that 
the whole family must kneel down and say 
the Lord’s Prayer; they would then, the 
same evening, be taken up to heaven. He 
was therefore removed to hospital. 

At the hospital he lay quietly staring at 
the ceiling, murmuring prayers, and say- 
ing now and again, “Yes, I am coming.” 
On inquiry, he stated that he saw angels. 
He cried out loudly “I am Elijah,” and 
scratching himself so as to draw blood, 
wrote with blood on the door: “In the 
name of Jesus Christ, he is Elijah; behold 
they have seen him.” Afterward he grew 
calmer and talked to the nurses, whom he 
informed that just as it said in the Bible 
that John the Baptist was Elijah, so, too, 
he was Elijah; but ‘as John would not say 
why he was Elijah, he likewise would not 
say.” 


[95] 


Morbid Mental States 


The patient was later discharged from 
hospital and returned to his home, but his 
behavior was still strange. He stuck to 
his religious ideas and acted accordingly, 
gave away money belonging to his family, 
for the benefit of poor children, wrote arti- 
cles on religious subjects, and distributed 
them gratis in the streets, sold old furniture 
and gave away the money, all the time 
neglecting his home and his work and con- 
stantly receiving visits from angels and 
prophets. 

The state of things at home becoming 
more and more intolerable, he was again 
taken to an asylum. 

On admission here he looked a veritable 
prophet, with long hair and beard, and old, 
discolored clothes. He behaved with sto- 
ical calm and dignity, and answered will- 
ingly and in friendly fashion when asked 
about his. thoughts and his “call.”? God 
had applied to him directly, laying on him 
a great task: to declare to the people a 
new truth, to warn a sinful generation of 


[96] 


Religion and Incurable Insanity 


the Day of Judgment, and make plain the 
dark passages of Scripture to us all. 
When asked whether he should not work 
for his living, he answered, “And did not 
the prophets of old receive food and cloth- 
ing, though they did not work, and the 
people shook their heads?” If asked how 
it was he knew more than other people, he 
answered: ‘God has enlightened my eyes 
and called me a prophet before His face. 
Edison was only a newspaper boy, but he 
became a great inventor, after all. The 
meanest among us may hit upon the deep- 
est truths.”—“Yes, but up to now, nothing 
has come of your prophecies.” Answer: 
**None knows the secrets of God; the Spirit 
alone knows what dwells in man.”—“‘Yes, 
but if you go on like this, you will end in 
a lunatic asylum.”—“It is not supposed to 
be easy for one who seeks only to do God’s 
will. ‘The chosen shall suffer want and ad- 
versity. I have suffered a good deal al- 
ready, but I know I am treading the path 
of the Lord.”—“Yes, but what about your 


[97] 


Morbid Mental States 


family ?”—“Is it not written that Jesus is 
come to set strife between man and wife? 
The family will get on all right without 
me,”’ etc. 

In the course of his stay at the asylum 
this patient wrote three big books, with the 
following titles: ‘“Mene Tekel,” ‘The 
Day of Judgment is Come,” “The Flood is 
Coming.” In these we read, inter alia: 
“The Day of Judgment is come, all the 
signs are there, the elements are on fire, 
pestilence is broken out among us, and the 
Beast is arisen out of the bottomless pit. 
It has pleased the dear Lord to let mine 
eyes fall upon a word in the Bible, and I 
have set myself to write a revolutionary 
sermon against the present social order. 
The conflagration of the world is come, the 
great war that is as a surprise to us all, as 
a thief in the night is the beginning of 
Judgment Day, which is to last seven 
years, and when the sun shall set at noon 
and then comes the night, and the court 
without the temple shall be trampled down 


[98] 


Religion and Incurable Insanity 


for months, when it shall be known who re- 
main faithful in spite of adversity and who 
will refuse to receive the Mark of the 
Beast,”’ ete. 

In conversation, this patient gave one 
the impression of a calm and collected per- 
sonality, ready to suffer persecution for 
his faith. His speech was slow and meas- 
ured, interlarded with scriptural phrases 
and texts, but not without originality, and 
always logical or pseudo-logical. He suf- 
fered throughout from hallucinations, in 
a quiet fashion, but mostly at night; saw 
angels and devils with whom he conversed, 
and persons deceased. One day he threw 
a lamp along the floor, crying out, “Get 
away, you old Satan!”’ 

As he continued calm and quiet in his be- 
havior, he was discharged, and continued 
his eccentric and pathological missionary 
work. 

We will now proceed to consider another 
group of incurable mental diseases, which 
I mentioned at the commencement of this 


[99] 


Morbid Mental States ~* 





lecture, namely, juvenile dementia, or de- 
mentia precox. ‘This disease is one of the 
saddest of all mental diseases, partly from 
the fact that it commences in youth, and 
partly from its horrible character, and the 
fact that it is incurable. It consists in a 
dissolution of the personality and a grad- 
ual break-up of the patient’s mental life. 

Juvenile dementia, or dementia precox, 
begins, as the name suggests, in youth, 
generally between the ages of fifteen and 
twenty-five, and not infrequently in con- 
junction with puberty. The first stage is 
often that a young man or woman, so to 
speak, comes to a standstill mentally. 
They lose interest in their work, become 
dull and unreliable, cannot keep their situ- 
ations or attend to their studies, and suffer 
reproaches from their relatives on that ac- 
count. At the same time, however, their 
character also begins to change in a dis- 
tressing manner. ‘They cannot be trusted, 
they tell lies and shirk their duties, commit 
acts of extravagance and take things on 

[100] 


Religion and Incurable Insanity 





credit; often they commit some more or 
less serious offense against the law, and are 
reprimanded by the authorities. Up to 
this stage, however, no one has any idea 
that it is a case of incipient insanity, and 
not a few crimes are committed in the in- 
itial stages of dementia precox. 

One day, however, these patients begin 
to make curious statements. They talk 
about being affected inside their bodies by 
magnetism, and of people speaking to them 
by wireless telephony. They feel as if 
there was a “machine” inside them making 
a noise, and there are people trying to 
draw the “‘life force” out of them; or there 
is somebody “putting thoughts into their 
heads” or “taking their thoughts.” It 
may also appear that their intestines have 
got loose, the spinal marrow has fallen 
down, or they have been sealed up inside 
so that evacuation is impossible. Some- 
times they also hear voices; somebody calls 
out “thief” or “murderer” after them in 
the streets and when alone in a room; they 

[101] 


Morbid Mental States 





see horrid sights—fire and sulphur, angels, 
devils, etc. ; there is a smell of smoke about, 
and a poisonous taste in the food (hal- 
lucinations). 

These symptoms are naturally not of- 
ten all present at once, but only appear 
one after another; nevertheless, the rel- 
atives of the sufferer are alarmed, and be- 
gin to understand that it is a case of in- 
sanity. ‘The doctor is called in, and the 
patient removed to an asylum. 

At the asylum they sometimes begin with 
an attack of derangement which may be of 
the most violent and distressing character 
ever seen in these cases of psychosis. 
They are confused and restless, with pow- 
erful hallucinations. The sun has fallen 
down from the sky, flames envelop the 
earth and all the world is on fire, hell opens 
to swallow them up, ghastly figures ap- 
pear on every side, voices cry aloud of mur- 
der and beheading, God and the devil, 
blood and crime. And in this state of ex- 
treme excitement and terror the patients 

[102] 


Religion and Incurable Insanity 


may die; they can rave themselves to death 
and wear out their physical strength; the 
heart becomes exhausted, the temperature 
rises, and then follows unconsciousness and 
death. 

Such a termination, however, is rare. 
Generally, the derangement passes off, and 
the patients grow calmer. But the attack 
leaves them more or less psychically de- 
fective. ‘Their wits are duller than before, 
their character further changed, their 
judgment is gone; in a word, there are 
symptoms of incipient dissolution of the 
personality. This process of dissolution 
goes on slowly, but surely, increasing dur- 
ing the next few years—aindeed, for the re- 
mainder of their lives. They may live to 
a fairly old age, but they can, in the later 
stages of the disease, fall to a degree of im- 
becility where every sign of humanity is 
extinguished, and they show themselves in 
many ways lower than the beasts; as, for 
instance, by devouring their own feces. 
They have to be helped in every little 

[103] 


Morbid Mental States 


thing. If you stand them up somewhere, 
they remain standing till they are moved; 
if you make them sit down, they remain sit- 
ting till some one moves them again. They 
have to be fed and washed, dressed and 
cleaned like infants. They are spiritually 
dead. 

The course of events here described is 
naturally only to be taken as a rough, 
schematic presentation of the disease. It 
would be altogether wrong to draw con- 
clusions from this as to any individual 
case, for there are few diseases so capri- 
cious and fickle as dementia precox. 
There may be long periods of improve- 
ment, when the patients can be sent home 
and given a little work to do, so that for a 
time they may appear to be cured. But it 
is a feature common to the different varia- 
tions of the disease that the patient’s men- 
tal life becomes gradually restricted and 
reduced. 'The finer forms of soul-life are 
gradually destroyed. Intelligence, feeling, 
and will give place to an increasing imbecil- 

[104] 


Religion and Incurable Insanity 


ity. It is supposed that the disease arises 
from intensive, organic alterations in the 
brain-cells, alterations which can, in the 
more advanced cases, be discerned under 
the microscope. But what is the ultimate 
cause of this destruction of the brain we 
do not know. It is at present supposed 
that it may be due to a kind of auto- 
intoxication, proceeding from some small 
glands in the body; this, however, is only 
hypothetical. 

Now it is not uncommon for patients 
suffering from dementia precox to have 
religious ideas, and these may be of a 
varied and remarkable character. It is 
indeed characteristic of all ideas in this 
strange and distressing psychosis that they 
crop up in the patient’s brain in an irregu- 
lar, incoherent, haphazard fashion, inter- 
woven in an extraordinary degree and pro- 
ducing a complete state of chaos. It 1s 
hard to give any notion of these conditions 
except by quoting examples. I take a 
couple at random: 

[105] 


Morbid Mental States 


Cas—E 12.—A young woman was ad- 
mitted to Section VI on the ground that 
she had become incapable of work and af- 
fected with strange religious ideas. She 
was a student, but neglected her studies; 
had lately been drifting about in religious 
dreams. At the hospital she appeared 
vacuous, indifferent, and void of feeling. 
She talked little, but one day she an- 
nounced that she was the bride of Jesus, 
and was to be “‘married to the Holy Ghost.” 
On another occasion she declared she felt 
a child inside her—it must be the infant 
Jesus. It was impossible to bring her to 
reason, inter alia, because she heard voices 
telling her she was to be the mother of 
Jesus. She had also other symptoms of 
chronic insanity, namely, stereotyped 
ideas, mannerisms, odd attitudes, repeti- 
tion of words, and obstinate resistance. 
This state of things lasted without a break 
for several years, then she became violently 
deranged, shouting and screaming, run- 
ning about the room and delivering long, 

[106] 


Religion and Incurable Insanity 


incoherent monologues; the devil was after 
her, God would save her, the earth was 
opening under her feet, life welled up in 
her breast, etc. She had visions of vari- 
ous sorts—piercing eyes, red dragons, the 
Lord God Himself. Voices cried: “Strike 
her down! Who is she that blasphemes 
the Holy of Holies?” ‘This state of things 
gradually subsided and gave place to one 
of mental vacuity. She is now almost en- 
tirely imbecile, and has to be looked after 
like a child. 


Somewhat in contrast to this case, which 
we might call one of religious delirium, oc- 
curring episodically in the course of a 
chronic insanity, is the following, where 
fixed ideas of a religious character are 
more constantly in evidence: 


Case 13.—A young lawyer in a good 
position and with every prospect of a dis- 
tinguished career began to neglect his 
work and took to dissipation. He drank, 
took drugs, and exhibited various forms of 

[107] 


e 
Morbid. Mental States 





sexual perversity, and, losing all initiative, 
went rapidly downhill in social respects. 
One day he began talking nonsense about 
being the “Man from the North” and 
“Ruler of the Solar System.” A new star 
had appeared in the heavens, he said, and 
this had reference to himself ; it meant that 
he was divine, or that he was “evil and good 
in one person.” It might also be that he 
was “a new form for the reappearance of 
Christ on earth.” He had marked hal- 
lucinations from time to time, was terrified, 
restless and confused. One day he threw 
his watch at the devil and smashed it. As 
an instance of his monologues with reli- 
gious tendency may be quoted the follow- 
ing: “I thought I was God—I could be 
saved by Jesus Christ—no, I am eternally 
lost and doomed to punishment through 
all eternity—I am God and Satan in one, 
you understand? I am God to mankind 
and Satan to my brothers. I know I am 
hopelessly mad and would rather die.” In 
a letter to his relatives he wrote: 
[108] 


Religion and. Incurable Insanity 





DeEar It is a long time since I wrote 
you last. I did not think I was God then, but 
I think so now. Yes, I believe I am God and 
Satan in one, and the worst of it all is that 
Christ has gone to hell, and what that means 
only you can tell me. And I believe, too, that 
I am to be burned eternally—dreadful, is n’t 
it? But then I think evil again and believe I 
can live for a day; a day is a thousand years 
or one, I don’t know, for then, of course, you 
would be God to Satan for a thousand years, 
and I don’t think the world will last longer 
than that—etc. 


You perceive how difficult it is for a nor- 
mal human being to discover any meaning 
or coherence in the utterances of such pa- 
tients. It is sometimes positively painful, 
in a physical sense, to try to follow their 
erratic thoughts. They may live for 
years talking in this incoherent fashion, 
and are as a rule entirely absorbed in their 
confused ideas, with no interest in their 
surroundings. Fortunately, we may say, 
it is rarely that their emotional state cor- 
responds; I mean, they do not feel as an 

[109] 


Morbid Mental States 





ordinary person would necessarily feel 
when uttering such things. For these pa- 
tients become altogether blunted and de- 
void of feeling. They do not always suf- 
fer as one might suppose. This is evident, 
for instance, from the fact that they may 
grow fat and enjoy the best of bodily 
health at the same time that their utter- 
ances are of the type above noted. Con- 
sequently, they often live to a considerable 
age. 

Here is an instance of the development 
of dementia precox in a theological stud- 
ent: 


Cast 14.—This was a patient whose 
family had shown marked disposition to 
insanity. He had studied, theology for 
five years and done well, and was now read- 
ing for his final examination. He then be- 
gan to feel religious scruples and to lose 
interest in his work, spent his time going 
for long walks with folded arms, and spec- 
ulating on “‘problems.” He would kneel 

[110] 


Religion and Incurable Insanity 





down and pray for hours at a time, kiss the 
floor, and declare he was a spirit. He 
was admitted to hospital, and exhibited 
here an attitude of superiority and self- 
satisfaction. He was not ill; the whole 
thing was a misunderstanding—the doctors 
would be called to account for this, etc. (a 
thing one often hears). Occasionally his 
behavior was strange: he would le down 
flat on the floor, and stay there for hours 
as stiff as a ramrod, or stand up against 
the wall with his arms extended. One day 
he declared that he was “the greatest theo- 
logian and the greatest doctor,” and also 
“the Father of God the Father Himself.” 
On another occasion he said he was en- 
gaged on a great work which he had come 
to carry out here on earth; it was some- 
thing in the direction of exterminating sin 
and poverty on earth; but he added: 
“God the Father can keep His angels to 
Himself. Devil take me if I don’t manage 
the whole thing on my own. God and all 
His angels, Satan and all his devils, and all 


ined By 


Morbid Mental States 





mankind, I can do in the whole lot of them 
by my own strength in three minutes!” 
He has now been twenty years in an asy- 
lum, is dull, self-centered, brooding over 
his mad thoughts; now and again, how- 
ever, he asks to be discharged, as “there is 
work waiting for him as a missionary.” 


In addition to these two forms of insan- 
ity, there are also a number of others, 
which it would take too long to discuss 
here. 

It may be of importance, however, to 
note that in practically every form of in- 
sanity we may find fixed ideas of a religious 
character. And this applies to diseases 
arising out of definite and well-known or- 
ganic causes, as, for instance, syphilitic 
cerebral paralysis, or arterio-sclerotic de- 
mentia (senile dementia). Even in alco- 
holic delirium the patients may have rey- 
elations of eternal bliss or suffer the tor- 
tures of hell. 

[112] 


Religion and Incurable Insanity 


There remains now one question which 
naturally arises in this connection, and 
that is: How are we, as Christians, to re- 
gard the problem of incurable insanity 
and its place in the order of the universe? 
What can be God’s purpose with these 
poor demented persons? 

I shall not here go into what the Bible 
says on this point. The Bible, as we 
know, takes in most cases a view of insan- 
ity in accord with that of those times 
in regard to mental disturbance. 

It seems to me, however, immediately ob- 
vious that no Christian can possibly re- 
gard insane persons as spiritually dead. 
They cannot be annihilated, their soul-life 
cannot have perished altogether, as one 
might suppose from their outward appear- 
ance. It is incompatible with the belief in 
God’s loving-kindness to think that this 
should be so; it is incompatible with our 
faith that salvation is within the reach of 
all. That which has once lived, as a per- 

[113] 


Morbid Mental States 





sonality, cannot perish or be effaced. It 
must live, in some form, somewhere or 
other. God alone knows where it is. 

When I go about among my insane pa- 
tients, I find help and comfort in the 
thought: they are not dead, but sleeping. 
Their consciousness has left them, as con- 
sciousness leaves us when we sleep. ‘They 
lie there helpless, devoid of all volition, un- 
able to control their bodies, but in their 
subconscious existence there must be a life 
accessible only to the one who lives it, and 
visible only from within. It is the same 
with persons under an anesthetic: as long 
as the ether or the chloroform binds their 
brain-cells, they appear as if dead, lack- 
ing all sign of mental life. But they are 
not dead. They awake when the effect 
of the anesthetic passes off, and not one 
of their functions of consciousness has suf- 
fered in the least. ‘The soul once more 
takes possession of the body, whole and un- 
impaired, and they return to life. 

Sleep and narcosis, then, are analogous 

[114] 


Religion and Incurable Insanity 





to the incurable psychoses, and though 
these analogies may be imperfect in many 
respects, they afford us nevertheless a 
slight support for the belief—and here we 
touch on a question of faith, pure and sim- 
ple—that the incurably insane will wake 
some day, will know their dear ones 
again, and will themselves be capable of 
spiritual life. It is possible—who can 
say ?—that they may be able to thank us 
for what we have done for them while 
they lay in their trance, or reproach us 
for what we have failed to do. 

This is my own belief, and though it 
may be called arbitrary or irrational, it is 
nevertheless a help to me. It is more than 
a help; it is a necessity ; without it, I could 
not live and work as I do among the insane 
with courage, and hope, and unshaken 
faith in the loving-kindness of God. 


[115] 


LECTURE IV 


RELIGION AS A CAUSE OF INSANITY, AND 
SPIRITUAL TREATMENT OF THE INSANE 


HEN a person becomes insane, 
and goes to a doctor or is ad- 
mitted to hospital, there are various 
questions which the doctor nearly al- 
ways has to answer, and on which the 
friends are most anxious for enlighten- 
ment. The questions are: What is the 
matter with the patient? Can he get well 
again? How did the disease arise? How 
is it to be treated? We have already con- 
sidered the first two questions, namely, the 
nature and course of the disease. We 
shall now consider the last two questions, 
namely, the causes and treatment of men- 
tal diseases. 
Does religion drive people mad? ‘This 
[116] 


Religion as a Cause of Insanity 


is the first question which we shall en- 
deavor to answer. 

That religion drives people mad is an 
assertion often heard, especially when one 
has, as a doctor, occasion to talk with in- 
sane persons and their relatives. We of- 
ten hear, when a person has been admitted 
to a lunatic asylum, observations of this 
sort: “My wife has gone mad; it was all 
through going to those meetings and to 
church.” Or, “My daughter was always 
one of the holy sort, and it seems to have 
turned her brain.” The form of expres- 
sion may vary considerably, but the mean- 
ing is always the same. And it would 
seem as if persons well or ill disposed to- 
ward religion are equally liable to say such 
things. People who bring an insane per- 
son to the asylum are always much dis- 
tressed and upset, and in such a state are 
apt to speak without restraint. 

The question now is, whether this asser- 
tion is right or wrong, from a medical and 
psychological point of view; for if it be 

[117] 


Morbid Mental States 


correct, then the fact must be admitted 
without reserve, even by those well disposed 
toward religion; but if it be erroneous, 
then it will be to the interest of all parties 
to lay this ancient ghost once and for all. 
It must do a great deal of harm, especially 
among certain classes of people, where it 
serves as a pretext for disregarding sacred 
things. 

As far as I can see, there are three ways 
of getting an answer to the question as to 
whether religion drives people mad. The 
first is by examining the annual reports of 
the mental asylums; the second, by an ex- 
amination of the opinions of well-known 
psychiatrists ; and the third, by a consider- 
ation of the cause of mental disease gen- 
erally. 

A small booklet is published annually in 
Denmark under the title of ““Reports from 
the State Mental Asylums and St. Hans 
Hospital.” In this booklet we find infor- 
mation communicated from the six lunatic 
asylums in Denmark regarding patients 

[118] 


Religion as a Cause of Insanity 


admitted, deceased, or discharged during 
the year, and there is also—as a relic of 
former times—a section devoted to ‘‘Causes 
and Conditions Relative to Patients Ad- 
mitted.” If we take, for instance, the re- 
port for 1916, we find among the more 
common causes of insanity the following: 
Hereditary tendencies, about 40 per cent. ; 
abuse of alcohol, about 5 per cent. ; arterio- 
sclerosis, about 4 per cent.; climacteric, 
about 3 per cent.; physical diseases, about 
5 per cent. ; and syphilis, about 10 per cent. 
Among the causes more rarely found we 
may mention at random: Over-exertion, 
1-2 per cent.; emotional strain, about 5 
per cent.; economical difficulties, 1 per 
cent. ; and, in some of the reports, religious 
influence, to wit, in about 1% to 1 per cent. 
of the cases. 

That is to say that out of 1000 persons, 
400 became insane through one or other 
form of congenital defect, about 50 went 
mad through drink, and about 100 from 
syphilis, whereas only 5, or at the utmost 

[119] 


Morbid Mental States 


10, owed their insanity to religious influ- 
ence, or, as some of the hospitals prefer 
to put it, “unhealthy religious influence.” 
If we look back through earlier reports, we 
find a much greater number of alcoholic 
cases, owing to the fact that spirits were 
cheaper before the late war; and if we take 
St. Hans Hospital alone, which only admits 
patients from Copenhagen, the number of 
syphilitic cases is considerably greater, 
whereas psychosis due to religion is not 
mentioned at all. 

The importance of these figures is of 
course qualified. In the first place, be- 
cause it is based on a personal estimate of 
the causes of the disease and the chief med- 
ical officer’s personal sphere of interest; 
but also because it is never possible to say 
with certainty what was the true cause of 
insanity and what not. We can at the 
outside only speak of apparent or con- 
tributory causes. 

Nevertheless, these figures tell us this 
much at least: that religious influence is, 

[120] 


Religion as a Cause of Insanity 


according to the view of modern psychia- 
trists, a rare, a very rare cause of insanity, 
although it may occur as such. We shall 
see how later on. 

The second means of ascertaining 
whether religion makes people insane is to 
consult the utterances of well-known psy- 
chiatrists, of high authorities, on the point. 
I will here quote some few writers on the 
subject. 

Professor Oppenheim, in his book “Ner- 
venleidung und Erziehung,” says: ‘From 
my experience as a medical man, I reckon 
lack of faith as one of the most regrettable 
qualities. It seems to me that reiigion of- 
fers a strong, albeit by no means certain, 
support in the struggle against those pow- 
ers which attack the nervous system. A 
strong and firm faith is a safeguard 
against most of the emotions which the 
vicissitudes of life call forth in those lack- 
ing this support.” 

The late Dr. Krafft-Ebing, a _ well- 
known authority on mentai diseases, writes: 

[121] 


Morbid Mental States 


“Altogether, we may assume that true re- 
ligion, true ethical sense, ennobles the hu- 
man spirit and directs it toward something 
higher, affords comfort in adversity, and 
will reduce the danger of insanity.” J. L. 
A. Kock, head of the mental asylum at 
Zwiefaden, writes: “In so far as it is pos- 
sible at all to render mental life more re- 
sistant to harm through the nervous sys- 
tem, there is, at any rate to begin with, no 
other means but a certain resignation. 
And I will not conceal my opinion that the 
persons most capable of resistance to men- 
tal disturbance are those whose safeguard 
arises out of a living religious feeling.” 

Dr. Hyslop, principal medical officer at 
the Bethlem Mental Asylum, in London, 
considers that constant simple prayer must 
be granted the foremost place among the 
hygienic precautions which can counteract 
mental disturbance, depressed state of 
mind, and all the consequences of mental 
distress. 

The Danish mental specialist, Frode 

[122] 


Religion as a Cause of Insanity 


Krarup—aif we may be allowed to include a 
few Danish names—writes of the patients 
at Viborg Asylum as follows: ‘In the 
older journals, it is not altogether uncom- 
mon to find ‘lack of religion’ noted as a 
contributory cause, whereas nowadays peo- 
ple are more inclined to attach similar im- 
portance—somewhat unfairly, perhaps— 
to ‘exaggerated religiosity.’ Among the 
commonest mental contributory causes in 
patients at Viborg we find, first and fore- 
most, erotic experiences and disappoint- 
ments, and next, though far more rarely, 
religious anxiety.” And finally, Dr. P. 
D. Koch writes: “I cannot, from my own 
experience, quote a single case where re- 
ligious influence or emotion has given rise 
to insanity. And I am speaking from an 
experience of something like a couple of 
thousand cases of insanity, of whom I have 
had close personal knowledge in my pri- 
vate practice, and this, moreover, particu- 
larly among religious people. If any- 
thing is to be done seriously to check the 
[123] 


Morbid Mental States 





spread of insanity, it would be more useful 
to direct such endeavors towards combat- 
ing syphilis and alcoholism than to attack 
religion.” 

Taking all these expressions of opinion 
together, we must say that they do not to 
any great degree suggest that religious in- 
fluences should be held responsible for in- 
sanity ; rather, indeed, the reverse, namely, 
that religion is a safeguard against insan- 
ity. It is possible, however, that other 
opinions may be found tending in the op- 
posite direction, but I have not, despite the 
perusal of a very great amount of liter- 
ature on the subject, been able to find any. 
And there is one fact which appears par- 
ticularly striking, namely, that the great 
psychiatric text-books, such as those of 
Krepelin, Bleuler, Binswanger and Sie- 
merling, make no mention at all of reli- 
gious experiences among the etiological 
factors in the psychoses, and especially 
not among the psychical causes. 

We may, then, venture to say that in the 

[124] 


Religion as a Cause of Insanity 


opinion of psychiatric authorities, religion, 
in the sense of a true and healthy attitude 
toward God, is not only harmless as re- 
gards mental health, but directly preserv- 
ative. 

- Let us now glance at the various causes 
of insanity, as far as these are known at 
all, and see whether this throws any 
further light on the subject. These 
causes may be divided into three groups. 

The first group is that of endogenous 
causes, which includes hereditary disposi- 
tion, pre-natal accident, puberty, the 
climacteric, pregnancy, etc. This is the 
largest and most important group. The 
religious element is obviously of no account 
here. 

The next group comprises exogenous 
causes, among which are reckoned bac- 
terial disease (e. g. influenza, typhus, tu- 
berculosis), poisoning (e.g. alcohol and 
morphine poisoning), accidents involving 
the head, and a series of physical diseases, 
including kidney trouble, diabetes, anemia, 

[125] 


Morbid Mental States 





myxcedema, Basedow’s disease, etc. ‘To 
these must be added the chronic cerebro- 
spinal diseases. . Here, of course, the re- 
ligious element is out of the question. 

But, finally, we have the third group of 
psychical causes, and it is here that we 
should expect to find religious experien- 
ces and religious crises. We know that 
sorrow and disappointment, mental trou- 
bles of all kinds, penal servitude and prison 
camps in war, can lead to insanity in per- 
sons predisposed toward it. ‘These are 
called psychogenous psychoses. The war 
has brought these diseases very much to 
the front. 

Now it would be highly remarkable if 
religious trouble and_ religious crises, 
doubts, conversions, and_ self-reproach, 
which can undoubtedly produce the great- 
est disturbance in the mind, should not be 
able to produce insanity. It would be 
underestimating the intensity of religious 
experiences if these alone were to be ex- 
cepted and not take equal rank with all 

[126] 


Religion as a Cause of Insanity 





other forms of mental disturbance which 
can, in suitable soil, break down the nor- 
mal barriers of the mind and lead thought 
astray. If love troubles and shell-shock 
can lead to insanity, a religious crisis may 
surely do so as well. It can, and does, as 
numerous examples have proved. ‘The 
question is, why it so rarely happens. 
Why is it only once in a hundred cases that 
it does so? The explanation must pre- 
sumably be that religious crises and pro- 
found religious experiences are altogether 
of rare occurrence. In our part of the 
world, people are carried toward religion 
rather by a soft gentle breeze than by 
violent storms. Do not the majority of 
people live rather on second-hand expe- 
rience or very mild and harmless religious 
feelings than on original conversion? 
This may, at least, doubtless be said of 
people in Denmark. 

But now comes the question: If reli- 
gion is so rarely a cause of insanity, as 
seems to be the case from the foregoing, 

[127] 


Morbid Mental States 





how can it be that so many people think 
otherwise? Even though they may be 
wrong, there must be some reason for their 
having that opinion. We can surely find 
something to account for it. 

The explanation is easy enough. It is 
due to a confusion of cause and effect, 
and an erroneous interpretation of the 
fact, of enormous importance in itself, 
to wit, that religious ideas are so extraor- 
dinarily frequent among insane persons. 
Indeed, we may say that no other class of 
ideas is so permanently represented in a 
mental asylum as the ideas of religion— 
unless it be those of a sexual character. 

We might quote numerous examples, 
but it would take too long to go mto 
the history of particular cases here. We 
need only think of melancholia, the com- 
monest of all psychoses, especially if we 
include its slighter form, depression; how 
often do we not find here religious anxiety 
and ideas of being eternally lost, a sinner 
beyond forgiveness, human or divine, hear- 

[128] 


Religion asa Cause of Insanity 


ing the voice of God cry, “All is over.” 
Or take mania, the opposite of melancholia, 
where thought races hurriedly on, while the 
patient is flushed and excited. How of- 
ten do we not find here that the augmented 
sense of importance and increased enjoy- 
ment of life find outlet in religious phrases 
and the idea of being the “Chosen of God,” 
or perhaps a gifted preacher, a famous 
singer, a “man after God’s heart,” as 
David was. Or think again of paranoia, 
chronic dementia, where, more than any- 
where else, we find “systems” with a re- 
ligious coloring. The man who calls him- 
self “God’s Prophet So-and-so,” and de- 
livers harangues on the new doctrines 
which are to make humanity perfectly 
happy; or the decent, hard-working little 
fellow who has suddenly become “the Mes- 
siah” for whom the world has been waiting, 
and who is now destined to renew heaven 
and earth! Even in juvenile dementia or 
advancing cerebral paralysis,—which, by 
the way, does not involve much inventive 
[129] 


Morbid Mental States 


power, but consists in a gradual dissolu- 
tion of personality,—even here we may 
meet with phrases of a pronounced religious 
character, with “God” and “‘the devil” and 
“the spiritual army of evil under heaven” 
pursuing and tormenting the unfortunate 
sufferers. Later, in the more advanced 
stages, it is mostly religious fragments and 
futile religious Utopias which dominate 
the scene. 

One might easily fill a book with the re- 
ligious ideas and experiences of insane per- 
sons, and I have, in the other sections, 
given examples of these; but what has 
here been said must suffice to show that it 
is a natural misunderstanding to regard 
religious feeling as a cause of insanity. 
In reality, it is rather the reverse, in that 
insanity gives rise to a certain kind of re- 
ligious impressions. It is the frequency 
of religious ideas in all forms and phases 
of insanity which misleads the layman and 
induces him to repeat the old catchword, 
that “religion drives people mad.” But 

[130] 


Religion as a Cause of Insanity 


it is really the reverse! It is insanity 
which produces a kind of religious excite- 
ment and gives vent to religious thoughts 
and longings. 

And now we might further ask: Why 
are religious ideas and experiences so fre- 
quent in cases of msanity? There are 
various answers to this question. 

We may say, for instance, that in a 
Christian community all persons are im- 
bued from childhood with religious ideas; 
at school and at home, in confirmation 
classes and at church, at funerals and meet- 
ings they have imbibed a sum of Christian 
knowledge which may well be latent in 
their daily life and under normal condi- 
tions, but makes itself felt in the hour of 
need. And the hour of need is certainly 
the hour of psychical suffering; it is then 
that one turns to the old truths as the only 
ones that offer any support. 

But again we may say, from an entirely 
different point of view, that religious ideas 
are a mere jumble of nonsense to people, a 

[131] 


Morbid Mental States 





sort of mystic protecting charm which the 
sufferers stammer out in the hours of dark- 
ness. Just as the wanderer by night 
makes the sign of the cross when he meets 
a ghost, so also insane persons make the 
sign of the cross when they find themselves 
in the dark night of mental disease. They 
attach no profound meaning to the thing. 

Without venturing to deny that these 
two explanations may have a certain prob- 
ability, I will nevertheless maintain that 
the frequency of religious ideas in cases of 
insanity is of far deeper origin, in that it 
is related to the primitive character of re- 
ligious life. 

There is no doubt but that the majority 
of mental diseases reveal the total content 
of the patient’s consciousness to a very 
great extent, and remove the mask which 
most people wear to a certain degree in 
every-day life. Mental trouble is thus a 
merciless exposure of ourselves. All that 
is inherent in the personality comes to the 

[132] 


Religion as a Cause of Insanity 


surface, and things before unsuspected be- 
come clear as day. It is the same with re- 
ligious matters. Religious life becomes 
powerful and violent in psychosis, because 
it is a primitive thing, a primitive tend- 
ency, a natural inclination, an instinctive 
craving, which may be suppressed in many 
people in every-day life, but in psychosis 
breaks forth strongly and violently, inflex- 
ibly and uncontrollably, resembling in this 
respect the sex instinct and the craving for 
food. 

There is matter here for interesting 
studies in the psychology of religion, for 
the point is one that has been too little re- 
garded by religious psychologists up to 
now. 


We must, however, leave the question as 
to the origin of mental diseases, and turn 
to the other vitally important question we 
have to deal with here, namely, that of 
their treatment. This is, of course, a prin- 

[133] 


Morbid Mental States 


cipal consideration with all who have to 
dea] with insane persons, and I should like 
to give some directions here. 

I may perhaps be allowed to begin with a 
word on behalf of the Danish mental asy- 
lums and their attendants. For the work 
of mental asylums is carried on under dif- 
ficult conditions, and often with remark- 
able opposition from the public. This 
applies both to those belonging to the con- 
gregation and those that do not; and the ill 
will, or suspicion,—if one may call it so,— 
is the result of the views held in earlier times 
with regard to lunatic asylums. Because, 
at one time, lunatics in asylums were ill- 
treated, these institutions are still feared 
by many; but the attitude is unwarranted. 
The old wrong lies at the door of all hu- 
manity, and it is unfair that lunatic asy- 
lums should be blamed more than others. 
We have given up the old name of lunatic 
asylums, and now call them mental hos- 
pitals; and in the same way, a reformation 
has taken place within the walls, so that 

[134] 


Religion as a Cause of Insanity 


of the ancient prisons virtually nothing 
now remains in our modern hospitals; 
openness, homeliness, comfort, and beauty 
are prominent in most of our mental hos- 
pitals, and sound, modern methods of 
calming refractory patients have super- 
seded the old strait-jacket and the padded 
cell. 

Clergymen and others who have to deal 
with insane persons can therefore quite 
confidently refer them to our hospitals and 
asylums. And as a rule the same applies 
also to cases of psychosis with a marked re- 
ligious character. For though there may, 
of course, be functionaries at the hospitals 
who fail to recognize the importance of 
religious life, and some perhaps who may 
speak derisively of the same, this is not the 
general rule. From my own knowledge of 
Danish mental hospitals I can assert that 
most of the functionaries and, at any rate, 
most of the doctors nowadays have due re- 
spect for religious values, and would not 
speak disparagingly of what is sacred to 

[135] 


Morbid Mental States 





others. In this regard, also, there has 
been a change since the old days of lunatic 
asylums. 

On the other hand, it must of course be 
admitted that the Christian mental hos- 
pital is the ideal institution for patients 
from Christian homes, or even for patients 
with pronounced religious psychosis. It 
does undoubtedly give such persons a cer- 
tain feeling of security and mental well- 
being to be surrounded by people who un- 
derstand them and share their view of life, 
even though they may not talk much with 
them about such things. The ideal ar- 
rangement, then, is that which prevails in 
Holland, where there are three kinds of 
hospitals, one for Protestants, one for 
Catholics, and a third for the so-called 
“neutrals.” All these hospitals are sup- 
ported equally by the State, on the sensible 
and humane principle that when people 
become insane they should be placed in the 
surroundings where they properly belong 
in spiritual respects. They are not forced 

[136] 


Religion as a Cause of Insanity 


to live during psychosis in a spiritual en- 
vironment alien or hostile to them. The 
Protestant mental hospitals in Holland all 
belong to one great “Society for Christian 
Treatment of the Insane,” which has no 
fewer than four hospitals, and a psy- 
chiatric university clinic with 2500 pa- 
tients in all. 

As regards the spiritual treatment of 
the insane, I must admit that, as far as my 
experience goes, its value is very limited. 
All that can be done for insane patients 
from a purely humane point of view is, as 
I have already explained, to treat them 
with tact and friendliness, with deep hu- 
man sympathy indeed. And what we can 
do for them from a Christian point of view 
is to surround them with a spirit of Chris- 
tianity, that is to say, place them in the 
care of people who understand their calling 
and its responsibilities, and spare no pains 
to treat them in the spirit of Jesus Christ, 
as far as this lies within the power of frail 
human beings. This is in itself a very 

[137] 


Morbid Mental States 





great deal, when we look at it from the 
right side. Try, therefore, to procure 
Christian nurses for the patients. ‘Try to 
arouse your congregations to a realization 
of the sufferings of the insane. And give 
the institutions which will undertake the 
care of the insane in Jesus’ name the ma- 
terial means they need. Refrain from 
criticizing the work, though it may be far 
from perfect, but rather lend a helping 
hand where opportunity arises. This is 
in the main the solution of the problem as 
to the congregation and the insane. 

But apart from this indirect treatment, 
spiritual means avail very little in the case 
of insane patients, as is obvious from the 
nature of the case. How can we hope to 
cure by spiritual means a disease due to 
physical alterations in the brain? This is, 
however, the case with most psychoses, and 
the treatment must therefore be physical, 
not spiritual; or more correctly, physical 
and spiritual at once. Where the physi- 
cal therapy aims chiefly at soothing and 

[138] 


Religion as a Cause of Insanity 


sparing, the spiritual therapy must also 
follow the same lines. The patients must 
be put on a strict spiritual diet, just as 
they are put on strict physical diet. The 
first principle of medicine is nil nocere, 
and this should also be the first principle 
of spiritual aid when dealing with insanity. 

But how is such a spiritual diet to be 
formulated? Can any suggestions be 
made in this respect? 

I will endeavor to give a general outline 
which may perhaps be some use as a guide. 
The details can only be learned by daily 
practice. 

In dealing with cases of melancholia, it 
is of course necessary as far as possible to 
counteract the hypochondriac fixed ideas 
and self-reproaches, including those of a 
religious character—such things as the 
fear of hell, consciousness of sin, convic- 
tion of being eternally lost, etc. In any 
case, these symptoms must not be encour- 
aged or augmented; care must be taken 
not to afford, by word or prayer or read- 

[139] 


| 


; 
| 
} 


Morbid Mental States 





ing matter, any material for further mor- 
bid ideas. ‘The Bible must in some cases 
be taken away from the patient. The Bi- 
ble is, indeed, a book for healthy minds, not 


\ for minds diseased. Patients suffering 


from melancholia are particularly inclined 
to pick out passages which they can turn 
into self-accusation, showing that they are 
utterly lost, that they have sinned against 
the Holy Ghost, that God is an avenging 
God, and so on. Such passages, for in- 
stance, as “Many are called, but few 
chosen,” references to hell fire and eternal 
damnation and the like, have given rise to 
great distress of mind in many cases. In 
pronounced cases of melancholia, one 
should at any rate allow only certain sel- 
ected parts of the Holy Scriptures to be 
read, as for instance the Gospel according 
to St. Mark, or portions of the Psalms. 
The hymn-book may be used in slight cases. 
But here also care must be taken. It is 
surprising what a patient suffering from 
melancholia can make out of a simple hymn 
[140] 


Religion as a Cause of Insanity 





and how the simple truths of Christianity 
can be distorted. At certain stages of the 
disease all spiritual reading is undesirable. 
The patient must be placed on what is 
called Diatum absolutum, that is, no food 
whatsoever. 

And further, it must be borne in mind 
that when talking to melancholia cases, it 
is no use arguing with them, for fixed ideas 
are not to be dispelled by logical argument. 
This is just what characterizes them as 
fixed ideas, the fact that they cannot be so 
dispelled. Prolonged argument, the quot- 
ing of text, or reference to theological au- 
thorities only tires the patient; he may, 
perhaps, for a moment admit the truth of 
what is said, but as soon as the visitor has 
left the room, doubt and unrest return with 
renewed force. And why? Because the 
sick brain has been fatigued and the sick 
mind further disturbed. What is needed 
is rest, rest, and again rest, and, as a rule, 
confinement to bed for a lengthy period. 

But a thing which can be done for mel- 

[141] 


Morbid Mental States 


ancholia patients suffering from religious 
anxiety, and always should be done by 
those who have the requisite spiritual au- 
thority, is to propound the Gospel of God’s 
mercy and God’s love. 'This should be 
done briefly, clearly, simply, and with as 
much impressive power as Christian faith 
can command. ‘Take such a text as this: 
‘““God so loved the world that He gave His 
only begotten Son to the end that all who 
believe in Him should not perish, but have 
everlasting life.” Or this: “He who be- 
gan a good work in you will perfect it un- 
til the day of Jesus Christ,” etc. This 
should be stated as forcefully as possible. 
Tell the patient that these words are truth 
to you, and that you have proved their 
truth. Tell him that you are well, and he 
is ill, and therefore it is you that are right- 
and he that is wrong. And repeat it every 
time you see him. Do not be afraid of 
repetition. The talk of insane persons is 
stereotyped, and their treatment must be 
[142] 


Religion as a Cause of Insanity 


on the same lines. I remember how I my- 
self have said the same thing over and over 
again, every day for months at a time, to 
patients of this class, and afterward they 
have thanked me for it. Spiritual com- 
fort can be administered like medicine, that 
is to say, a teaspoonful three times a day. 

Should one pray with the insane when 
they themselves wish it and ask it? 

The question is difficult to answer in a 
general way. Much depends on the nature 
of the patient and the disposition of the 
spiritual adviser. As a rule, I think we 
may say that it is better to pray for the 
insane than to pray with them; and pray- 
ers for them should be offered up in the 
privacy of one’s chamber. Prayer is an 
act which calls for concentration of mind, 
if it is to be effective, and the sufferers are 
not capable of this. Moreover, the pray- 
ers of the insane may often be sprinkled 
with the ideas of insanity and produce a 
most distressing effect. My own recollec- 

[143] 


Morbid Mental States 





tions of attempts in this direction are not 
such as to tempt me to repeat them.+ 

As regards the spiritual treatment of 
mania and maniac exaltation, this natu- 
rally consists in soothing and calming, in 
contrast to melancholia, where the patient 
rather needs stimulating. The main thing 
here is to help the patient not to over- 
estimate his own powerful feeling of hap- 
piness and pathological ebullitions of feel- 
ing (cf. the cases cited in Lecture II). 
These patients may, you will remember, ex- 
perience a religious awakening which is 


1The question as to spiritual care of melancholia 
patients is a very extensive one, and may call for 
independent consideration. I will only add here that 
the Epistle to the Hebrews vi. 4-6 may cause great 
anxiety to those suffering from depression, and also 
the story of Judas Iscariot, whose dark fate fills the 
sufferers with fear of predestined perdition. It is 
easy to understand also that such parts as Revela- 
tion are among the most dangerous in the Bible to 
those whose thoughts are already astray. In con- 
trast, we may note some passages calculated to 
give the troubled soul rest and comfort, and which 
may well be used by the spiritual adviser, viz. Isa. 
Ivii. 15, Matt. xi. 28-80, Mark if. 17, John vi. 37, 
the Psalms, e. g. the xxiii., etc. 


[144] 


Religion as a Cause of Insanity 


only an apparent conversion, in that it does 
not originate in God’s intervention, but is 
an outcome of the patient’s own altered 
mood. ‘Take care, then, not to make a 
mistake in such cases. View with some 
scepticism and timely reserve all sudden 
conversions occurring after long periods of 
depression. For though they may be gen- 
uine, they may also be false and superficial. 
By their fruits ye shall know them. 

It remains now to consider religious ideas 
in patients suffermg from paranoia and 
hallucinations—in a word, those affected 
by chronic and incurable psychoses. Spir- 
itual treatment is here, of course, out of 
the question save in a purely negative 
sense, that is, to the extent of not contra- 
dicting, and thus irritating, the sufferers. 
Laymen are rather apt to err in this direc- 
tion. But fixed ideas are not to be eradi- 
cated by “‘sound logic”; they would not be 
“fixed” ideas if they were. We can no 
more persuade Patient X, who considers 
himself the Prophet of God, to admit that 

[145] 


Morbid Mental States 


he is no prophet, than we can convince 
Patient Y, who believes himself to be God 
Almighty, that he is anything else. It 
only does the patients harm to talk about 
their fixed ideas, and the treatment must 
consist in leading their thoughts in other 
directions, which is best effected by means 
of work. It is for this reason that the 
system of providing patients with a defi- 
nite occupation takes such a prominent 
place in our modern mental hospitals. 
There is wide scope for the spiritual ad- 
viser in the treatment of convalescents, 
that is, the numerous cases of those who 
have passed through a psychosis. A great 
deal of good can be done in this way. Such 
persons are often in a difficult position in 
respect to their religion. For those who 
have once been insane find it hard to adapt 
themselves to life again; they have, as it 
were, been driven out of their course, and 
have to start afresh. And very often the 
fact that they have been insane is a great 
stumbling-block to them in their religious 
[146] 


Religion as a Cause of Insanity 


feelings; they cannot understand how God 
could have so dealt with them. They bear 
a grudge against existence for the horrors 
it has revealed to them, and they doubt the 
goodness and the loving-kindness of God. 
In this they are at times confirmed by see- 
ing the unfriendly manner, the strange 
aloofness with which others meet them at 
the gates of the asylum; and there is every 
reason then that the clergy should render 
all the aid they can. They must help such 
persons to find a meaning in existence. 

And finally, one more word: Do not 
forget to pray for the insane. Jesus Christ 
has Himself taught His flock to care for 
the afflicted in mind. He cured many who 
suffered from diseases of the mind; and 
we are acting in the spirit of Christ and 
following His example when we mention in 
our prayers not only the sick and the fallen, 
the poor and suffering, but also the insane. 

Pray God to help those who are in dark- 
ness, in the incomprehensible darkness of 
insanity. 

[147] 


‘ 


LECTURE V 


RELIGION AND NERVOUSNESS 


HERE is one point of great impor- 
a tance to all whose work lies among 
the sick, and that is that every serious form 
of bodily suffering has a corresponding 
mental counterpart of some sort and in 
greater or less degree. 

It is a fact known from of old, which all 
have learned from experience, that illness 
renders people sensitive and occasions a 
mental change in them. But it is strange 
that this fact should have been so little 
noticed by spiritual advisers, that they 
rarely take it into consideration when visit- 
ing the sick. They do not sufficiently 
reckon with the peculiar mental state of 
sick persons when speaking or writing for 
their benefit. They have, in a word, neg- 

[148] 


Religion and Nervousness 


lected the psychology of the sick-bed. 

I will illustrate what I mean by one or 
two examples. 

A man is suffering, let us say, from dys- 
pepsia. He was formerly a cheerful and 
sensible person, contented with his lot in 
life and happy in his work, his home, and 
his little pleasures. Now he is constantly 
suffering pain and discomfort, has to ob- 
serve troublesome rules of diet, rest, and 
exercise, go to bed early, and take medi- 
cine. All this affects his mental attitude; 
he was an optimist before, but now he be- 
comes a pessimist! He was an idealist be- 
fore; now he is a materialist! His range 
of interest has become lessened; he be- 
comes more and more introspective. He 
turns gloomy, morose, and _ ill-balanced. 
People about him note the change with 
some surprise; what has come over him? 
Has he lost money, or is there some trouble 
at home? Nothing of the sort. He is 
suffering from dyspepsia, that is all. 

Take another case. A man develops 

[149] 


Morbid Mental States 





kidney disease accompanied by increased 
blood-pressure and heart trouble—the com- 
bination is not uncommon. His psychic 
state will alter simultaneously. Once ro- 
bust and self-confident, he becomes weak 
and feeble-tempered, he shows a lack of 
sympathy, or indeed positive hostility, to- 
ward all that is brisk and healthy, smart 
and active and forceful in life. He com- 
plains of heaviness and giddiness, and acts 
at times in an altogether unexpected fash- 
ion. Little trifles irritate him beyond 
reason; he flares up at the slightest thing. 
What is the matter with the man? Is it 
drink, or sheer wickedness? Not at all; it 
is simply illness. He is suffering from a 
serious physical disease with mental com- 
plications. 

We might point out many other abnor- 
mal states of body and mind together. 
Heart trouble may give rise to fits of in- 
explicable terror, and, not infrequently, 
positive fear of death. A diseased liver 
may lead to sluggishness of thought and 

[150] 


Religion and Nervousness 


marked depression, with irritability, due 
to poisons allowed to escape into the blood. 
Chronic anemia with low blood efficiency 
may occasion weariness, heaviness of mind, 
and disinclination to work. Fever may 
give rise to euphoristic conditions, when 
the patient sees everything in a brighter 
light than that of reality, as, for instance, 
with consumptives. A disease in certain 
small glands with so-called “internal se- 
cretion” may produce the most remarkable 
alterations in the personality of the suf- 
ferer, as we know from affections of the 
genital glands and others. In a word, 
there are a number of physical diseases 
which exert a profound influence on the 
mental state; it is indeed questionable 
whether any physical disease is altogether 
without some mental correlation. 

For we must bear in mind that there are 
two factors which act together and sup- 
port each other in producing an abnormal 
mental state: firstly, the effect of the dis- 
ease on the brain itself, and secondly, the 


[151] 


Morbid Mental States 





isolation and alteration of circumstances 
occasioned by the illness. This latter must 
not be overlooked or underestimated. ‘The 
fact that a person physically ill is uprooted 
from his accustomed ways, removed from 
intercourse with his friends, and forced to 
look to others for help and attendance; 
sometimes confined to bed for a lengthy 
period, and worried by uncertainty as to 
the future and perhaps difficulties in meet- 
ing present obligations—all these are in 
themselves sufficient to induce a state of 
mental depression; and it is not strange 
that people on a sick-bed appear alto- 
gether changed in character from their 
normal state when active and at work. 
The spiritual adviser must take all this 
into consideration. He must, so to speak, 
feel the sick man’s pulse in a spiritual 
sense. He must be able to diagnose the 
mental state before commencing treatment. 
Just as a good doctor does not attempt to 
treat a patient until he has made his ex- 
amination and arrived at a diagnosis, so 
[152] 


Religion and Nervousness 


also a spiritual healer should never pro- 
ceed to treatment without having diag- 
nosed the case; that is, he must first find 
out what is the weak point, and what are 
the spiritual needs. And this he can only 
ascertain by letting the sick person speak 
freely, and by putting questions himself, 
wisely, insistently, patiently and with tact, 
until he has got at the inmost heart of the 
trouble. Only the quack presumes to give 
treatment without examination, and apply 
the same medicine to all cases alike. 
Therefore, all spiritual treatment of the 
sick should begin by letting the patient 
talk, and listening unwearyingly to all 
that he has to say. The spiritual adviser 
has always to listen before he can advise; 
but this is more particularly the case when 
dealing with sick persons. The sick per- 
son needs to talk of his trouble, and has 
ample leisure to do so; and his confidence 
increases the more he feels he can talk 
freely. Seek, then, to expose the hidden 
suffering behind a mask of calmness; try 
[153] 


Morbid Mental States 


to find the weak point in the individual 
case. Analyse your patient just as a 
nerve specialist does, in the expectation of 
finding—as will often be the case—some 
hidden mental suffering behind the nervy- 
ousness; the repressed painful complexes, 
as German writers have accustomed us to 
call them. For these are the real root of 
the trouble. 

After this little digression, we will pass 
on to our main subject, which is, neuras- 
thenic and hysterical conditions and their 
relation to religous feeling. 

We may begin by asking: What is 
neurasthenia? 

And it must be admitted that it is hard 
to find a satisfactory definition of the word, 
for experts have not yet agreed on the 
point. In the main, it means nerve- 
weakness, or nerve-weariness; that is, a 
state of things well known in every-day 
life. The patient complains of feeling 
tired and disinclined to work, is irritable, 
and suffers from headaches, insomnia, gid- 

[154] 


Religion and Nervousness 





diness, palpitation, cold feet and trembling 
hands, blood flushing the head—in a word, 
a number of symptoms which may be very 
troublesome, but are often highly incon- 
stant and variable. Sometimes the pa- 
tient is altogether preoccupied with his own 
condition and cannot concentrate on any- 
thing else. Sometimes he may feel elated 
and fit. But the work is done irregularly, 
in heavy bouts, and the patient collapses 
after a long spell of work. The Germans 
call this condition retzbare Schwdache, which 
is very characteristic. The patients are 
reizbare, that is, irritable, easily affected, 
easily set in motion, but at the same time 
weak, lacking in reserve of strength. 

The question now is: How does this form 
of trouble affect the religious life? 

The answer is not difficult to give. 
These persons suffer from reizbare Schwa- 
che, or irritable weakness, also in their 
religious life. There is naturally an in- 
timate relation between the state of the 
nerves and the soul-life as a whole, and con- 

[155] 


Morbid Mental States 





seqently the latter will be like the former 
—weak, sensitive, easily tired, incapable of 
effort, ill-balanced. ‘The sufferers can, 
from a religious point of view, pull them- 
selves together for a while, chiefly by arti- 
ficial stimulants, by talking with others, 
for instance, and going to church or to 
meetings and the like; and in this condi- 
tion they may display a certain amount 
of energy and forced activity. But they 
cannot keep it up. They collapse again 
after a short time, and have periods of 
slackness, where the sense-impressions have 
free play and the personality is at their 
mercy, affording a melancholy example of 
man’s dependence on physical conditions. 
They try again and again to advance in 
their spiritual life, but with no real suc- 
cess. ‘Their prayers, their study of the 
Bible, and their deeds stop half-way, be- 
cause their nerves fail them. They can- 
not carry anything through to the end, 
and under the impression of their own in- 
efficiency they become more and more 
[156] 


Religion and Nervousness 


apathetic and resigned. They gradually 
get the idea that they are wicked in them- 
selves, that is to say, hopelessly weak- 
willed, impossible people, capable of noth- 
ing at all. And they do not realize that 
they are more than wicked; they are ill, 
and often more seriously ill than they them- 
selves believe. They need medical treat- 
ment. 

Such conditions may be met with not in- 
frequently among the workers in our con- 
gregations, such as priests and mission 
workers, secretaries in the Y. M. C. A. and 
Y. W. C. A., and similar undertakings. 
These men and women are often too lavish 
of their nervous energy; their clubs and 
committees and meetings entail too heavy 
a strain on them; they are always having 
to exert their personal influence, talking 
earnestly to one and another, making 
speeches to a crowd, going late to bed, and 
doing without their proper holidays, and 
soon. It proves too much for them in the 
long run. And in many cases the result is 

[157] 


Morbid Mental States 


a serious breakdown in health, which may 
take years to put right. A nerve special- 
ist with some practice among young peo- 
ple of this type can speak from experience. 
And one cannot cease wondering at the 
fact that neurasthenia is so little known 
and so little respected. Young men and 
women are allowed to work for years at 
half-speed or at a forced pace, and worn 
and wearied priests in the capital pre- 
side at meeting after meeting without tak- 
ing any heed of their nervous state. At 
last there is nothing to be done but give 
them a holiday for six months or a year, or 
appoint them to the cure of a desert island, 
to bring them back to health. Is this 
right? 

Neurasthenia is a disease which must be 
treated as such, and it must be taken in 
hand before it becomes chronic. For the 
treatment of acute neurasthenia is not dif- 
ficult, and is one of the most gratifying 
tasks a nerve specialist can have. The 
treatment begins as a rule with confine- 

[158] 


Religion and Nervousness 


ment to bed for a period, in order to give 
the patient complete rest and restore nor- 
mal sleep. ‘The diet is so arranged as to 
make patients put on flesh, which is often 
badly needed, and consequently acts rap- 
idly, a short time sufficing to bring about 
an increase in weight and improvement in 
appearance. Massage, baths and lying out 
in the open air are employed in addition, 
and suitable medicines given, the quantity, 
however, being often very limited. Later 
on, when the worst of the weariness and 
unrest has passed off, physical (and men- 
tal) strength is encouraged by work in the 
open air, walks, light carpentering, gym- 
nastics, etc. Finally, a change of air and 
scene may be used to complete the cure. 


Casr 15.—Medical student, age twenty- 
two. Comes of a family with disposition 
to nervousness and has previously (at the 
age of puberty) suffered from nervous at- 
tacks. A high-minded and sensitive young 
man with humane and Christian interests. 

[159] 


Morbid Mental States 





During the past six months he had been 
reading very hard for an examination, and 
at the same time working in the Christian 
Students’ Union, in addition to which he 
was worried about his sister, who was ill. 
Now complains of fatigue, insomnia, ir- 
ritability, lack of courage and energy, 1m- 
paired resistance to temptation; suffering 
also from headache, palpitation, fits of 
shivering and weeping for no apparent 
reason. Lost about 25 lbs. in weight. 
Objective examination showed no sign 
of organic nerve trouble. Lungs and di- 
gestion normal, but numerous symptoms of 
increased irritability and low fatigue limit. 
Treatment: three weeks in bed with bro- 
mide and arsenic, extra nourishing diet 
(cream, malt, eggs, etc.). From third to 
fifth week: light general massage and 
breathing exercises, and lying out two 
hours daily in the open air. Gained 20 lbs. 
in weight. Fifth to eighth week: walks 
and carpentering on a regular time-table. 
After two months, holiday in Norway, with 
[160] 


Religion and Nervousness 





walking tours around Jotunheim. Com- 
plete cure, with physical and spiritual fit- 
ness. Harmony in the spiritual life. 


Now I will not attempt in any way to 
conceal the fact that it is not all forms of 
neurasthenia which can be cured as easily 
as this. ‘There are regrettable forms of 
neurasthenia which are very difficult to 
treat, are, indeed, practically incurable. 
For they arise not from overstrain or phys- 
ical disease, but from an abnormal dis- 
position of the nervous system, a congenital 
defect. They can, no doubt, be helped 
and improved for a while, but there is al- 
ways a relapse, and the sufferers may 
spend their whole lives in a ceaseless strug- 
gle against their bad nerves. 

These cases afford an excellent op- 
portunity for doctor and spiritual adviser 
to work together, namely, in teaching pa- 
tients to cut their coat according to their 
cloth, and to use to the best advantage the 
power they have. For it is certain that 

[161] 


Morbid Mental States 


there would be fewer unhappy persons in 
the world if those who have been given but 
a small talent and little strength would 
realize the need for economizing what they 
have, instead of ever complaining because 
they are not better off. Our task here is 
of a dual character; we have in the first 
place to help them to arrange their lives 
in a sensible manner, and secondly to teach 
them not to complain of the inevitable. 
In both directions the religious life is of 
great importance. Religion—when earn- 
est and of true moral force—gives to the 
weak a power of resistance against tempta- 
tion which they cannot obtain elsewhere, 
and helps them to renounce enjoyments 
which may be harmful to their constitution 
(social functions, theaters, spirits, tobacco, 
harmful amusements, etc.). It throws 
light on the importance of small things, 
and creates an inclination to cultivate what 
is desirable and leave the rest alone. But 
more particularly, religion gives a spiritual 
center, a psychic strength which nervous 
[162] 


Religion and Nervousness 


people need more than others. It helps 
them most of all to collect their powers 
and find a meaning in life, as well as in 
their own lives. 

A firm religious conviction is therefore 
the greatest advantage and the best of 
medicine such persons can have. It is bet- 
ter than rest-cures or bromide, better than 
exhortations to “pull themselves  to- 
gether”; for what such patients need is a 
firm faith in life, a living belief in Chris: 
tianity. More than once I have heard 
nervous patients say: “If I had not had 
my religious life to fall back on, it would 
have been all over with me long ago. I 
should have gone mad or committed sui- 
cide.” And in this they are undoubtedly 
right. Professor Oppenheim, in his book 
“Nervenleidung und Erziehung,’ cor- 
rectly says that ‘Religion affords a strong, 
though by no means certain, support in 
the struggle against those powers which 
attack the nervous system.” 

And for this reason, nerve sanatoria 

[163] 


Morbid Mental States 





based on Christian principles, and guided 
by a Christian spirit, are of the greatest 
importance; more, indeed, in one way, 
than the Christian mental asylums already 
mentioned, inasmuch as they aim at help- 
ing people who are capable of grasping 
the essentials of Christianity, and greatly 
in need of it, which unfortunately is not 
always the case with the insane. But such 
nerve sanatoria must of course be run on 
proper medical lines. They must offer 
the patients the best that modern medical 
science has to give. ‘They must be con- 
ducted in a rational manner and on mod- 
ern principles, not following one-sided or 
fantastic ideas, such as vegetarianism, 
water-cure, or faith-healing ; this gives the 
place a bad reputation among sensible peo- 
ple and brings it out of touch with truth. 
The congregation must procure properly 
trained doctors to manage such institu- 
tions; only in this way will they be fit for 
the great and important task which lies be- 
fore them at the present day, when nerv- 
[164] 


Religion and Nervousness 





ous patients are so numerous. It is in- 
deed strange that the Christian congrega- 
tion in Denmark has not already estab- 
lished a Congregational Nerve Sanator- 
ium, for we find in neighboring countries 
good examples of nerve sanatoria on Chris’ 
tian lines, especially in Germany and Hol- 
land. In the latter country there is, in- 
deed, a great society which cares for nerv- 
ous patients on Christian lines. 


We will now proceed to consider the 
second of the great neuroses which may be 
of importance to the spiritual life of the 
sufferer, namely, hysteria. And I must 
here at once observe that I am not propos- 
ing to discuss the clinical aspect of hysteria 
any more than its individual symptoms. 
I shall only touch on certain aspects of 
the disease, which are of importance from 
a religious point of view, especially modern 
theories as to the origin and treatment of 
hysteria, and shall consider the hysterical 
constitution in relation to its surroundings. 

[165] 


Morbid Mental States 





Hysteria is a disease which shows itself 
partly in hysterical fits and partly in a 
chronic alteration of the character, which 
we call the hysterical constitution. We 
will take the two separately. 

Hysterical fits are probably known to 
you all, at any rate from hearsay. You 
are aware that certain persons, especially 
women, may be subject to peculiar fits of 
spasm or paralysis, shivering or weeping, 
stumbling gait or dumbness, pains or vom- 
iting, even blindness or deafness—with no 
real organic disease to account for the 
symptoms. 'The phenomena are produced 
by erroneous ideas in the brain of the pa- 
tient, but no physical alteration is any- 
where discernible, and the trouble really 
consists in their “thinking” they are lame 
or blind, deaf or in pain, without any cor- 
responding organic defect, i.e. while the 
organs in question—eyes, ears, limbs, ete. 
——are perfectly sound. 

Now it must not be supposed that hys- 
teria is the same as affectation or malinger- 

[166] 


Religion and Nervousness 


ing. The patients do not want to be ill; 
indeed, their illness often causes them great 
distress, and they do all they can to get rid 
of it. But the ideas which produce the 
trouble lie deep down in their subconscious 
mind, and are not easily removed. Some- 
thing mysterious is taking place in those 
hidden depths, and producing physical re- 
sults, but the patients themselves are not 
capable of controlling or resisting the 
“something,” whatever it may be, that op- 
erates in their subconscious mind. They 
do not, as a rule, know that it is there at all. 
They think the trouble really lies in arms 
and legs or eyes and ears. And it is only 
expert medical knowledge which can dis- 
cern the hysterical origin of the phenom- 
ena; that is, show that they originate in 
ideas, and not in organic defects. 
Hysterical attacks mostly occur when 
the person is in trouble of some sort. Dif- 
ficulties or disappointments, sorrow or fear 
or adversity, may suddenly produce these 
fits of paralysis, blindness, or pains here 
[167] 


Morbid Mental States 





and there. It has been said that hysterical 
persons have recourse to hysteria as a kind 
of refuge, that is, they choose the childish 
and primitive mode of avoiding difficulties 
by running away, by being ill. They hide 
their heads, after the manner of the os- 
trich; but it is a subconscious action; it is 
involuntary. 

In seeking for the painful event which 
has given rise in any particular case to the 
hysterical phenomena, modern nerve spe- 
cialists, and particularly Freud, of Vienna, 
assert that the painful event may lie far 
back in the past, in a subconscious recol- 
lection of happenings from childhood or 
youth, which the patient has otherwise for- 
gotten. It may, says Freud, be a matter 
of trouble at home or at school, unhealthy 
influence in childhood or youth, especially 
sexual errors and abuses, now long forgot- 
ten, but still painfully present in the sub- 
conscious. ‘These recollections form pain- 
ful complexes, the normal reaction to which 
has been repressed. And they have now 

[168] 


Religion and Nervousness 





to be brought forth into the clear light of 
consciousness, so that the patient can be 
cured. The doctor’s task, then, is first of 
all to find the complex in question by a pro- 
cess of mental analysis, and then to remove 
it by making the patient realize that it is 
there, and that the trouble is due to that 
cause and no other. 

This modern theory of the treatment of 
hysteria has, it is true, been somewhat ex- 
aggerated and overdone, especially by 
those who attribute practically all hysteri- 
cal phenomena to some sexual experience 
or unsatisfied sexual desire; but it has nev- 
ertheless been largely justified. For it 
has shown the great importance of mental 
conflicts as a cause of disease, and the fun- 
damental importance of such disharmony 
in producing mental disturbance. 

And it is here that we reach the point 
of interest in our particular inquiry, as 
to the relation between religion and nerv- 
ousness. It is necessary that priests should 
know the modern theories as to the origin 

[169] 


Morbid Mental States 





of hysteria, inasmuch as they can here 
learn two things which they ought to know. 

Firstly, that mental abnormalities may 
be due to painful experiences in the past, or 
troublesome conflicts in a person’s life, or 
unsatisfied longings and desires, which are 
not discernible at a first glance, which may, 
indeed, be unknown to the patient, but 
nevertheless undermine health and produce 
nervous disorder. And unless we can dis- 
cover these sources of wnrest, hidden but 
still flowing, we can never hope to render 
real assistance or effect a cure. All spir- 
itual treatment must be preceded by a 
mental analysis. The priest must, like the 
nerve specialist nowadays, learn to seek 
and search, listen and penetrate into the 
spiritual life in order to find the causa 
morbi, or cause of disease. Hour after 
hour, day after day, month after month, 
he must carry on his psycho-analysis. It 
takes time. Psycho-analysis is not quack- 
ery, but art and science in conjunction 
with extreme patience and the will to ren- 

[170] 


Religion and Nervousness 


der real aid. Lengthy and intensive ef- 
fort is here essential. 

This is the first thing which priests may 
learn from the modern treatment of hys- 
teria. Furthermore, the modern theory 
warrants the conclusion that if mental un- 
rest and nervous attacks may be due to un- 
satisfied longings and inner disharmony, 
they may also be due to unsatisfied relz- 
gious longings and the lack of peace with 
God. ‘The religious longing is, as we have 
already mentioned, in connection with the 
insane, a primitive impulse and a powerful 
craving in human nature. And this crav- 
ing or impulse,. whatever we may call it, 
can, like others of a similar primitive char- 
acter, produce nervous disorder when it re- 
mains unsatisfied. The clergy, then, can 
assist the doctors in this respect, by trac- 
ing any spiritual or religious trouble and 
remedying it as far as possible. The 
priest must render spiritual aid in his own 
particular sphere, that is, the sphere of re- 
ligion, and if he can restore the patient to 

[171] 


Morbid Mental States 


spiritual health, that is, restore the sufferer 
to calm and surety in religious matters, he | 
is directly aiding the work of the medical 
expert. Physician and priest have one 
great interest in common, namely, the task 
of aiding mankind to attain peace and har- 
mony, health and happiness. 

But there is still more to be said in re- 
gard to the treatment of hysteria. 

The cure of hysterical attacks is effected 
by eradicating from the subconscious mind 
of the patient those morbid ideas which are 
the cause of the trouble. This is, of 
course, the logical method of proceeding 
according to the theory above mentioned. 
But it is often a very difficult matter. 
The process of eradication often has to be 
effected by suggestive treatment, that is 
to say, by the authoritative introduction 
or removal of certain ideas. This is most 
frequently done by personal influence, 
where one person by virtue of his or her 
personal authority imposes on another 
certain ideas or certain feelings. What 

[172] 


Religion and Nervousness 


we have to do in cases of hysteria is to con- 
vince the sufferers that they are physically 
healthy despite their belief that they are 
physically ill. 

The suggestion can be effected in differ- 
ent ways. It may be given in the form of 
medicine which the patient believes will 
prove efficacious. It may be given in the 
form of an electric current passed through 
the body. It can be given by massage, or 
camouflaged as a “system,” preferably 
with the name of some well-known authority 
to support it. In every case it is faith 
that produces the effect ; faith in the means 
employed to effect a cure, and in the power 
of the physician to accomplish it. <Any- 
thing in which the patient confidently be- 
lieves can cure the disease, whether it be 
certain medicines, personalities, sacred 
waters, amulets, electric belts, magnetic 
vibration, wise women, or what not. ‘The 
latest idea is to employ certain breathing 
exercises (the Yoga system), or manipu- 
late certain vertebre (chiropractics), or 

[173] 


Morbid Mental States 





merely to repeat certain optimistic form- 
ule (Dr. Coué’s method). 

Here again, however, we touch on a 
point which must be of interest from the 
point of view of religious psychology, to 
wit, the cure of hysterical disorders by 
faith and faith alone. 

You will all be aware that there are cer- 
tain faith-healing movements which have 
from ancient times sought to cure people 
by faith and prayer alone. Such a pas- 
sage as that in James v. 14-15, to the ef- 
fect that the prayer of faith shall heal the 
sick, has served especially as a support 
for such movements, and, strictly speak- 
ing, it is perhaps impossible for an ear- 
nest Christian altogether to disregard 
the teaching of the Bible on this head. 
We must accept it in some way or 
other. 

As examples of faith-healing, we may 
take the holy waters at Lourdes, where 
hundreds of persons make pilgrimage 
every year to be cured by a miracle, step- 

[174] 


Religion and Nervousness 





ping down into the water while the Host 
is borne in procession by the priests. Or 
we can take the American Christian Sci- 
ence school, which declares that disease 
dces not exist for those who truly believe. 
Disease is merely a figment of the imagina- 
tion. It is against the nature of God that 
His creatures should be subject to such 
frailties. The whole art lies simply in be- 
lieving God’s word, and one is then cured. 
And many persons have actually been 
cured in this manner. In 1919 the move- 
ment had two millions of adherents and one 
thousand churches in America, besides 
four thousand healers. Also in other 
countries there are faith-healers to be 
found, There are little circles in Copen- 
hagen, for instance, where people assemble 
for the healing of the sick by laying on of 
hands and anointing them with oil. Nota 
few of my own patients have visited such 
circles and communities, and these move- 
ments are in reality far more widespread 
than is generally supposed. 
[175] 


- 


Morbid Mental States 


How are we, as Christians, to consider 
these phenomena? 

It is difficult, if not impossible, to say 
what actually happens in each individual 
case. ‘That God can heal people directly 
and by supernatural means will hardly be 
doubted by any Christian. The miracle 
is a possibility which we must reckon with, 
though it is probable that more miracles 
take place quietly than openly. A person 
who has experienced something of God’s 
mysterious power and marveled at the 
same, is not as a rule inclined to cry it 
aloud in the market-place. 

But there can be little doubt that a very 
great number of these so-called miraculous 
cures are really due to suggestive treat- 
ment of hysterical disorders. In the first 
place, people who have recourse to faith- 
healing are as a rule nervous and ill- 
balanced persons with an inclination to- 
ward the sensational and unusual in other 
ways as well. And further, it can be 
proved that no small number of patients so 

[176] 


Religion and Nervousness 


cured suffer relapse, namely, when the sug- 
gestion has worn off. Most nerve special- 
ists can probably quote instances of this. 
We see how patients come from their faith- 
healing, cured for a time, but only to suf- 
fer further hysterical attacks later on; and 
as a rule with an added bitterness, in that 
they feel themselves incensed against God 
for having disappointed their expectations. 
This confirms our assumption that it is not 
a question of miracles proper, but of or- 
dinary suggestive cure of nervous disor- 
ders, a cure which many doctors can effect 
by themselves quite as well as, or better 
than, the faith-healers, inter alia because 
they are aware of the dangers of sugges- 
tive treatment. 

It is of great importance, then, to real-. 
ize this, for you will, when you enter on 
your task in life, hear many remarkable 
stories of healing by faith. One should 
not always positively refuse to give cre- 
dence to such accounts, but it is as well to 
be sceptical. In the first place, hysterical 

[177] 


Morbid Mental States 





complaints are far more common than lay- 
men imagine, and almost every apparently 
physical trouble may be of hysterical or- 


igin, from chronic skin disease to serious = 


wounds and fever, or even abdominal tu- 


mors. And remember also that suggestive __ 
force is a very powerful agent and a re- 


markable healing factor which can pro- 


duce the most astonishing effects on the " 4 


sick. But it is not a divine force in the 


special sense; it is no more divine than are’ 
many other powers and forces which God 


has placed at our disposal. | 
The last point of interest in hysteria 


from a religious and psychological point 
of view, which we must briefly mention 

here, is the peculiar character and unusual = 
emotional life of these people, which we __ 
may comprise under the general term: hys- __ 


terical constitution. It means that hys- — 

terical persons are ill-balanced, unreliable, 

impulsive, theatrical, anxious to draw at-_ 

tention to themselves, to ‘‘make scenes,” 

and inclined to surprising explosive out- 
[178] 





Religion and Nervousness 





bursts of feeling, such as anger, hatred, 
temper, love, sorrow, jealousy, etc. It is 
as if they must always overdo everything; 
as if there grew up, from dark depths in 
the hysterical mind, strange flowers, odd, 
warped, uncanny growths of the imagina- 
tion, having no place in the world of real- 
ity. 

This dark depth in the hysterical mind, 
whence spring so many strange actions 
and sudden outbursts, is the subconscious 
region, here more active than in others. 
It has been proved by psychological tests, 
which we need not go into here, that few 
people have the subconscious mind _ so 
keenly developed as hysterical subjects. 
This is perhaps most marked in their tend- 
ency to dream-like experiences and hys- 
terical vapors, that is to say, a state of 
semi-unconsciousness where they go about 
as in a fog, and can, in the course of some 
hours or days, commit actions the effect of 
which they do not realize, and of which 
they are not afterward aware. They may 

[179] 


Morbid Mental States 





go off somewhere by train and make pur- 
chases, commit theft, or wander about in 
the fields and woods without any clear idea 
of what they have been doing. And these 
attacks are particularly lable to occur 
when something has upset the patient in 
some way, or some difficulty has arisen. 
They may be frequently repeated, until 
we get what is called a dual personality, 
where the normal ego is temporarily sus- 
pended and a new personality, unknown to 
the first, is formed, and acts and speaks 
like an entirely different person. As many 
as five different personalities may arise one 
after another in the same body, in the case 
of hysterical patients. 

We cannot here go further into the 
question as to the subconscious in its rela- 
tion to the normal consciousness. What 
we wish to point out is that religious life 
in hysterical persons is also of a very pe- 
culiar character, and that such individuals 
are especially inclined to sudden and unex- 

[180] 


Religion and Nervousness 





pected conversions and abrupt religious 
awakenings. 

An American psychologist, Dr. George 
Coe, has made a special study of the men- 
tality of persons who have experienced 
such religious awakenings. He gives, in- 
ter alia, the results of an investigation of 
the mental state of seventy-seven individu- 
als, all of whom had experienced a sudden 
or “acute” conversion. He believed it 
could be shown that all these persons had a 
very active subconsciousness. He formu- 
lates his conclusions to the effect that in 
persons with a tendency to sudden conver- 
sion, three psychic elements are found, 
namely, a choleric or melancholy tempera- 
ment, highly developed emotional life, and 
active subconsciousness. When these three 
factors are present, there will, he says, in 
nine cases out of ten, occur a sudden reli- 
gious change—provided that there is some 
external influence, and that the patient 
himself desires it; whereas on the other 

[181] 


Morbid Mental States 


hand, where these conditions are lacking, 
there will rarely, if ever, be any sudden 
transformation, even though the patient 
may wish it and even though external influ- 
ence may be present. This is interesting 
from a religious and psychological point of 
view. 

For the rest, I would recommend you to 
read this writer for yourselves, and at the 
same time I would remind you of William 
James’s “Varieties of Religious Experi- 
ence,” the foremost of all religious psycho- 
logical works. This last-named work 
gives a number of instances of acute con- 
version in persons of hysterical constitu- 
tion. 

It now remains to say a few words about 
a disease which does not belong to the 
mental diseases or nervous diseases proper, 
but is nevertheless of interest in this con- 
nection, owing to the morbid state of mind 
which the sufferers often exhibit, namely, 
epilepsy or the falling sickness. 

Epilepsy is a disease which often com- 

[182] 


Religion and Nervousness 


mences in youth or childhood, and makes 
itself apparent in convulsions occurring 
at certain intervals. These fits are of a 
very distinctive character in contrast to 
those of hysteria. The patient first ut- 
ters a cry, then loses consciousness and 
falls down, with convulsive movements of 
the arms and legs. The face turns blue, 
foam appears at the mouth, and the teeth 
often close on the tongue. When the con- 
vulsions have lasted a few minutes, they 
pass off, and the patient falls into a deep 
sleep, which may last for several hours; on 
awakening, he is perfectly well, but has 
generally forgotten all about the fit, only 
discovering it, as a rule, on finding that he 
has bitten his tongue or hurt himself in 
the fall, or when informed by others of 
what has taken place. 

Patients suffering from this disease 
tend, unfortunately, when the fits have 
lasted a certain number of years, and if 
not checked by treatment, to undergo a 
change of character. They become dull- 

[183] 


Morbid Mental States 


witted, lose memory, and not infrequently 
suffer a moral change for the worse. 
They become selfish, egocentric, mis- 
chievous, unreliable, irritable, hasty tem- 
pered, and sometimes develop criminal 
tendencies. Many of the worst crimes ever 
committed, such as murders, rape, arson, 
etc., have been the work of epileptics. 
Now it is a religious problem in itself 
that the human character can be so thor- 
oughly and so distressingly changed by a 
disease which from its whole nature ap- 
pears to be physical, and the effects of 
which may often be demonstrated in the 
brain after death. But it is not this side 
of the problem which we shall here con- 
sider, for the same arises in all insanity 
and all mental change occasioned by phys- 
ical suffering, and is not confined to epi- 
lepsy. There is another aspect of epilepsy 
which the clergy should note, namely, that 
epileptics are as a rule sensitive to reli- 
gious influence, and at the same time in- 
clined to morbid religious feelings. ‘The 
[184] 


Religion and Nervousness 


Germans call it “religiése Frommleret bet 
den Epieptikern.” Itis especially notice- 
able where there are many epileptics as- 
sembled in special colonies. They are 
ready and willing to receive the word of 
God, sing hymns, and are easily led into 
the life of faith; many of them may, in- 
deed, develop a true and deep religious 
feeling which proves of great importance 
to them in their lives. But there is an- 
other side to this religious tendency among 
these patients, namely, a certain tendency 
to morbid eccentricity; as for instance in 
self-righteous pharisaism, hypochondriac 
self-reproach, fanatic imaginings and self- 
mutilation—in a word, to many kinds of 
morbid excesses in religious life. This is 
a result of their epileptic disease, and it 
may spread epidemically to other epilep- 
tics, and should therefore be combated 
firmly by doctor and priest together. The 
spiritual care of epileptics is a special field 
in itself, and it is necessary to know the 
peculiar constitution of these patients in 
[185] 


Morbid Mental States 


order to give them the Gospel in the right 
way, 1.e., in such a manner as to render 
it of value to them in the deepest sense, and 
not harmful. 


[186] 


LECTURE VI 
RELIGION AND MENTAL DEGENERATION 


E have now finally to consider a 

series of morbid mental states 
which lie on the boundary line between san- 
ity and insanity, and which may be des- 
ignated by the common term of mental 
degeneration. 

In order to explain what is meant by 
mental degeneration, I must begin by re- 
minding you that we find, both in the ani- 
mal and vegetable kingdoms, certain ab- 
normalities which are not actual diseases, 
but merely indicate a deviation from the 
normal type in one way or other. We 
may, for instance, find odd wild shoots on 
the stem of a normal tree; and among ani- 
mals, we sometimes encounter variants dif- 
fering curiously from the rest of the spe- 

[187] 


Morbid Mental States 





cies. Degeneration among human beings 
may best be compared to such wild shoots 
or variants, and it would thus to a certain 
extent be better to use the word “devia- 
tion” in place of “degeneration,” inasmuch 
as we simply mean to imply that the indi- 
vidual is different from his fellows. He 
has deviated from the ordinary. He is a 
casus hominis of a peculiar kind and with 
a peculiar stamp of his own. 

And with regard to mental degenera- 
tion, we must first of all observe that it is, 
like all other troubles of the human mind, 
associated with the brain. All mental ac- 
tivity 1s seated in the brain, and mental de- 
generation is due to a fault in the cerebral 
structure. We do not know for certain 
whether it is a faulty arrangement of the 
cells, or a faulty structure of the cells 
themselves, or perhaps a functional defect. 
We only know that it is a purely physical 
disease of the brain which gives rise to the 
mental degeneration. 

Degeneration may be inherited or ac- 

[188] 


Religion and Mental Degeneration 


quired; in most cases it is a legacy from 
the parents. Statistics based on extensive 
material show that in degenerate families 
there are many cases of mental trouble in 
the form of insanity, nervousness, alco- 
holism, crime, suicide, and the like. These 
troubles can also occur in the families of 
normal people, but they are far more fre- 
quent among degenerates, and the reason 
is often that numbers of degenerate fami- 
lies intermarry, and the evil is thus in- 
creased, adding to its total from genera- 
tion to generation, until Nature steps in 
and puts an end to it by rendering the in 
dividuals sterile, when the race dies out. 
Mental degeneration can, however, also be 
acquired, a normal person being trans- 
formed into a degenerate; for instance, a 
blow on the head, cerebral inflammation or 
chronic poisoning, may produce degener- 
ative brain trouble. 

We will now run through various forms 
of mental degeneration, and especially 
those which are of importance to religious 

[189] 


Morbid Mental States 





life. I must first of all observe, however, 
that we have here a very wide field to cover, 
and an enormous number of mental phe- 
nomena, so that it is difficult to determine 
what should be included and_ what 
omitted. Strictly speaking, every marked 
peculiarity comes under the heading of 
mental abnormity. There are not a few 
persons who have some weak spot or other 
in their mentality. But it is only the 
types, and the particularly marked devia- 
tions which we shall here consider. 

I will take three groups: (1) Moral 
Degeneration; (2) Chronic Alcoholism; 
and (3) The Higher Degeneration (la dé- 
génération supérieure). 

You are all doubtless aware that a fa- 
mous Italian writer, Lombroso, has coined 
the term “born criminal” to indicate that 
certain persons are born, so to speak, with- 
out any moral disposition. They have 
not, as we have, a moral conscience to tell 
them what is right or wrong. ‘They are 
morally color-blind, and have thus to learn 

[190] 


Religion and Mental Degeneration 





everything from others. Lombroso as- 
serts that about one third of all criminals 
are born criminals, and these, in his view, 
the worst of them all. Whether this is 
correct or not, I will not venture to say. 
It is perhaps a somewhat high figure, for 
habits, temptation, and environment are 
doubtless responsible for most cases of 
criminal development. But Lombroso is 
undoubtedly right in pointing out that 
there are greatly varying degrees of moral 
resistance in different persons. 'The thing 
that tempts one and makes him a criminal 
does not tempt another. ‘There are thus 
persons (and here especially children) who 
are tempted beyond their power of resist- 
ance in modern society, and should there- 
fore never be allowed to go loose in it. 
They have a gap in their mental life, and 
this at the most unfortunate spot, namely 
in their moral sense. Consequently, they 
become a burden to their parents and a 
plague to the community in which they 
are brought up. 
[191] 


Morbid Mental States 





Let us analyze some of these moral de- 
generates a little further. They make 
themselves noticed at an early age by ob- 
stinacy and unruliness. No one can tame 
them. Even as children they go their own 
ways. Discipline has no effect on them. 
Appeals to their finer feelings are alto- 
gether futile, for they have none; their 
home and relatives are a matter of indiffer- 
ence to them, and they hate their teachers. 
If force is used, they kick over the traces, 
become wild and defiant, have fits of blind 
fury, and smash tables and chairs, or at- 
tempt their own lives or those of others. 
They soon form the idea that everybody is 
against them, nobody cares for them, they 
are unjustly treated and persecuted; and 
they may indeed develop fixed ideas in this 
direction, which lead them beyond the 
bounds of sanity. And when we further 
note that moral degenerates are thieving, 
lying, and mischievous, disinclined to any 
form of regular work, throw up one thing 
after another and play truant from school, 

[192] 


Religion and Mental Degeneration 


we have given some of the spiritual signs 
of this form of degeneration. We are 
here, of course, considering the most pro- 
nounced cases. 

I will give a few examples from the jour- 
nals of Section VI, which I am enabled to 
quote by the courtesy of Dr. Wimmer. 
All these are children. I have selected 
such cases as being presumably the most 
instructive for our present purpose. 


Casr 16.—A boy of eight, whose two 
uncles were drunkards and who had always 
been difficult to manage; steals, lies, and 
is generally ungovernable. His father de- 
clares that even the most severe thrashings 
have proved of no avail. He is brought 
to Section VI after having several times 
stolen things from his school, and had dur- 
ing the past ten months on ten separate oc- 
casions lit a bonfire in his parents’ house. 
Reason unknown. On = admission, he 
proved quick and alert, not lacking in in- 

[193] 


Morbid Mental States 


tellect, and passed all the usual tests of in- 
telligence with ease. But he is very trou- 
blesome here as well, and the other patients 
say he swears “like a trooper” (a boy of 
eight!). 


CasE 17.—A little girl of seven was ad- 
mitted to Section VI because her mother 
could not manage her at home. The 
mother states that the child has been quite 
unmanageable from the time she was quite 
small, violent tempered and extremely 
naughty. Has lately taken to running 
about the streets, and there learned a num- 
ber of abusive words which she uses freely 
toward her mother at home and in public. 
Had been brought up in a Roman Catholic 
school, but the nuns there will have nothing 
to do with her now, as she teaches the other 
children most abominable words. At the 
hospital she shows no particular signs either 
of physical or mental abnormality beyond 
being thoroughly naughty! Diagnosis: 
degeneratio psychopathica. 

[194] 


Religion and Mental Degeneration 





CasE 18.—A boy of fourteen is brought 
to Section VI as a vagabond. He has dur- 
ing the past six months three times run 
away from his work to go loafing about 
the streets or sitting in taverns and cine- 
mas spending money he has stolen. The 
reason for his running away is generally 
that he has stolen something, or is afraid 
of being punished for some other offense, 
and so stays away for several days. Sleeps 
at night in cellars and sheds and comes 
home in a dreadful state. The police 
think of sending him to a reformatory or 
to sea. 


Naturally, persons suffering from con- 
genital moral defects have always been a 
difficult problem in medical science as well 
as in law. In the old days they were 
treated according to the principle, “An 
eye for an eye, and a tooth for a tooth’; 
that is, society took vengeance on them for 
every crime they committed. Nowadays, 
however, humaner principles prevail, to 

[195] 


Morbid Mental States 





wit, those of the pedagogical system, which 
aims at educating instead of punishing. 
This is a natural outcome of the increas- 
ing recognition of the fact that we have 
here to deal with a true congenital defect 
of character, not merely intentional wick- 
edness. 

The Church, too, has in course of time 
done much for the cause of moral degener- 
ates, and this is why we are mentioning 
them here. Reformatories and homes of 
various kinds for young men and women 
who have been in trouble, prison missions 
and the like, have shown that the Christian 
community recognizes its duty toward 
these unfortunates. But if we may ven- 
ture here to criticize the work of the 
Church,—and we may perhaps be allowed 
to look at the matter in sober judgment,— 
it must be admitted that the Church has 
throughout the ages been extremely strict, 
and perhaps at times unfair in its demands 
with regard to these stepchildren of na- 
ture. Obviously, as long as the doctrine 

[196] 


Religion and Mental Degeneration 





of free will is insisted on as a fundamental 
principle—as it must be if there is to be 
any sense in the words salvation and per- 
dition,—it will be difficult at times to admit 
that moral faults may be due to congenital 
defects, and not solely to wilful wickedness. 
It is a difficult problem, but there can be 
little doubt that whatever our views on 
determinism or indeterminism, the Church 
has been somewhat severe in its judgment 
and somewhat pharisaical in its treatment 
of the so-called born criminals. 

It is highly desirable that the Church 
should, in the future, make some effort on 
behalf of moral defectives, based on a prac- 
tical and realistic consideration of the pos- 
sibilities of these persons. This does not 
mean that we should refrain from telling 
them the truth about their faults, or re- 
frain from holding up to them the great 
ethical ideals of Christianity. We do not 
lightly give up the attempt to restore the 
power of motion in a paralyzed arm, or the 
power of sight in a blinded eye; and sim- 

[197] 


Morbid Mental States 





ilarly, we should not neglect to encourage 
the development of moral sense in defective 
persons. The Church is_ particularly 
qualified to offer a helping hand in this 
respect. It holds that there are possibil- 
ities of development in every human being, 
and can thus meet them with confidence, 
which is just what they need. But we can 
demand of the Church that it shall be just. 
And justice will often force us to admit 
that these persons cannot, by any conceiv- 
able means, make their way in society as 
now constituted. They sink to the bot- 
tom, as a stone sinks in water, when ex- 
posed to the temptation of modern social 
conditions. And our aim should there- 
fore be not merely to preach and educate, 
but to isolate such persons, get them away 
from the unrest of society and give them 
peace. We cannot expect a paralyzed arm 
to grasp, or a blind eye to see; but we can 
provide the sufferers with extranéous aids 
and give them suitable conditions of life. 
The Church should be the servant of the 
[198] 


Religion and Mental Degeneration 





weak, and not only their taskmaster. 
The work of Mathilda Wrede among crim- 
inals in Finland, and that of Pastor Munck 
among the dregs of society in Denmark, 
are fine examples of profound Christian 
and true psychological attitude toward 
moral degenerates. 

And I must here mention a class of per- 
sons for whom the Church has done a great 
deal and to whom it has rendered admi- 
rable help in many ways, namely, cases of 
chronic alcoholism. 

We can, in the main, distinguish be- 
tween four separate forms of chronic alco- 
holism. 

Firstly, there are persons who drink be- 
cause of congenital hypochondria. These 
are people who have never really felt the 
true joy of life for any length of time and 
have from childhood been afflicted by a 
painful pessimism and weariness. They 
do not drink from any enjoyment of the 
drink itself, at any rate not at first; but 
they find it gives them bright moments, 

[199] 


Morbid Mental States 


drives away their misery for a while, and 
gives them a temporary feeling of well- 
being and content. Jack London has 
given an excellent description of this type 
of drunkard in one of his books. 

Then there are the periodical drunk- 
ards, who have occasional spells of drink- 
ing and can do without it in the intervals. 
Most of these are undoubtedly patients 
suffering from periodical depression. ‘The 
attacks do not actually begin with drink, 
but with a pronounced melancholy, in- 
somnia, and disinclination to work; and 
when this has reached a certain point, they 
turn to the bottle. They stumble through 
their depression in a more or less stupe- 
fied condition, but when, after a time, the 
depression passes off, they abstain, and 
feel no real need of alcohol. It is difficult, 
however, to diagnose this complaint, as 
many drunkards declare they are period- 
ical drinkers, whereas this is not really the 
case. ‘They endeavor by this means to ex- 
tenuate their vice, for the periodical 

[200] 


Religion and Mental Degeneration 





drunkard has, of course, some excuse for 
his occasional excesses. The best way of 
treating these patients is to deny them ac- 
cess to any form of alcohol as long as the 
depression lasts; if necessary, they should 
be placed in a hospital or private nursing 
home during the period. 

The third group is the largest, and com- 
prises those who suffer from congenital 
weakness of character, that is to say, true 
mental degenerates. These people, again, 
are not wicked in the ordinary sense, but 
they lack power of resistance. When ex- 
posed to temptation—and the conditions 
of modern society abound with tempta- 
tion—they fall. They may be otherwise 
decent and kindly souls,—the drunkard’s 
wife often exhibits a pathetic affection for 
her husband,—but once they get into bad 
company and taste drink, they almost in- 
variably begin to abuse it. The treat- 
ment of this type of patient is not always 
without its good effects ; it is carried out in 
an inebriate’s home. But we must not ex- 

[201] 


Morbid Mental States 





pect to make a permanent cure in every 
case, for there are very often relapses. 
The Blue Cross Home seems to have the 
best prospects here, for statistics prove 
that most cures take place there. ‘This is, 
of course, due to the fact that in these 
homes the patients’ minds are carefully 
stored with new ideas and feelings calcu- 
lated to increase their power of resistance 
in case of temptation. 

Finally, there is a small group of drunk- 
ards which is of great importance from the 
medical point of view, namely, those who 
take to drink at the initial stage of insidi- 
ously approaching insanity; and these are 
more numerous than might be supposed. 
Dr. Neve has described this form of alco- 
holism in his book on “Chronic Alcoholic 
Psychoses.” 

It would be a great thing if all endeav- 
ors toward the reclaiming of drunkards, 
including that of the Church, were based 
on a psychiatric appreciation of alcohol- 
ism, distinguishing between the different 

[202] 


Religion and Mental Degeneration 





groups, and treating each in its own way. 
There can be no doubt that this would give 
more adequate treatment of individual 
cases and be more economical socially. A 
great deal of time and effort is now spent 
on trying to help cases which from the 
medical point of view are already hope- 
Jess—cases in which the only course is last- 
ing confinement or isolation in colonies on 
little islands or in remote places. It is 
this, and not temporary improvement, 
which should here be aimed at. 


It remains now to consider the higher 
degeneration, or, as the French call it, la 
dégénération supérieure. 'This is a field 
as important as it is difficult to deal with, 
owing to the fact that a number of our 
most distinguished fellow-men have suf- 
fered from the disease, and it is almost im- 
possible to determine what is morbid and 
what is healthy. We are moving on a psy- 
chiatric border-line. 

The position here is best described by a 

[203] 


Morbid Mental States 





definite example. (The case here, like 
those previously given, has been somewhat 
altered in personal details for reasons of 
discretion. ) 


Casr 19 was a young man of one of our 
oldest families, that is to say, whose an- 
cestors had for many generations occupied 
high position in the country—a family, 
moreover, of a highly cultivated type, with 
artistic disposition and genius combined 
in the development of highly intellectual 
life. The family numbered several eccen- 
trics, some few cases of insanity, and many 
neuro-pathic subjects. 

The boy was nervous from childhood, 
but highly gifted, quick to learn and with 
a good memory, though somewhat super- 
ficial. He had a winning manner, smooth 
and pleasing, rather ingratiating, the type 
that is generally popular. He had also 
some artistic ability, sang and played and 
recited, acted very successfully in school 
plays. Naturally sensitive, he became re- 

[204] 


Religion and Mental Degeneration 





ligious while still at school, and, after a 
sudden and violent conversion, began 
working for the conversion of others. Be- 
came a member of the Y. M. C. A., and for 
some time acted as leader of a department 
here. 

Despite all this brilliancy on the sur- 
face, he was far from being happy, suf- 
fered from various morbid symptoms, 
which caused him anxiety and distress, 
such as headache, fits of terror, trembling 
hands, palpitation, and uncanny fancies. 
The sight of a knife made him think of cut- 
ting people’s throats, and when crossing 
an open square he would be seized with 
fright and imagine he was swimming in the 
midst of the ocean. His sex life too was 
marked by various abnormal features; he 
had to struggle hard against a morbidly 
accentuated sexual passion. 

For some time he seemed to be making 
a good career, but this suddenly came to 
an end. In the first place, he was found 
to have slight moral weaknesses, and on 

[205] 


Morbid Mental States 





one occasion effected a transaction with 
money not his own which led to his dismis- 
sal from a position of trust. And further, 
owing to the morbid character of his re- 
ligious life, he experienced a series of reve- 
lations, fell into mystic trances and saw 
visions, heard voices, etc., which produced 
a state of ecstasy for some time; in the in- 
tervals, however, he was altogether barren 
and blunted in religious feeling. Simul- 
taneously with these religious revelations 
he became entangled in a series of love- 
affairs which seriously affected his 
strength, and ultimately placed him in the 
doctor’s hands. 

Before this stage was reached he had, 
however, succeeded in writing a couple of 
quite good books, and had gained some 
reputation as a journalist. 


Now what can we gather from a case of 
this sort? What form of mental disease 
should we say was here in question? Was 

[206] 


Religion and Mental Degeneration 





the man sane or insane, normal or abnor- 
mal? 

In the present instance, we cannot say 
that he was insane in the true sense of the 
word. At any rate, his case does not come 
under any of the ordinary categories of in- 
sanity. ‘There was, perhaps, some indica- 
tion of neurasthenia, but this diagnosis 
would not suffice. And the same may be 
said of hysteria; for though there were 
several hysterical symptoms, there remains 
much which cannot be attributed to hys- 
teria. Nor was there anything to suggest 
epilepsy. 

In point of fact, this patient was suf- 
fering from superior degeneration. The 
disease is by no means uncommon in great 
old families; a description of it is given in 
Fr. Lange’s book on “Degenerate Fami- 
lies.” Our patient here exhibits various 
symptoms particularly characteristic of 
this form of degeneration, namely, extreme 
sensitiveness, artistic ability, inclination to 
mystical experiences, active and irregular 

[207] 


Morbid Mental States 


mental processes, uncanny fancies, sexual 
abnormalities, and slight moral defects. 
This form of degeneration seems indeed to 
include a mixture of everything found in 
all types of degeneration, but we find in 
particular one point which, as it were, 
raises these sufferers above the common 
herd, the “lower degenerates,” to wit, the 
touch of genius, the exceptional intellec- 
tual capacity. 

Some years back there appeared a book 
by Lombroso entitled ‘Genie und Irrsinn,” 
which has attained some degree of fame. 
In this book the author endeavors to prove 
that genius, and, indeed, all that is original 
and creative in the history of mankind, has 
always been marked by a pathological ele- 
ment. Artistic, scientific, and practical 
genius have always been found associated 
with disease, to wit, mental degeneration. 
If we go through the biographies of a se- 
ries of famous men, we find, according to 
Lombroso, that the greater number of 
them have suffered from fixed ideas, ab- 

[208] 


Religion and Mental Degeneration 





normal sensitiveness, alcoholic excess, sex- 
ual abnormity, fits, ete. And in most 
of these men of genius, the creative mo- 
ments, their true hours of inspiration, have 
been almost invariably associated with men- 
tal and physical symptoms of pathological 
character, often to such a degree as to in- 
dicate acute insanity, followed by renewed 
clarity of mind and relative cure. 

How far this assertion may be correct 
I will not venture to say. Lombroso’s 
book is perhaps somewhat fantastic, and 
his contributions to other fields of medical 
research have not always been able to stand 
the severest test. The point that inter- 
ests us here is that he demonstrates in 
many men whom we have accounted as of 
the highest distinction—including prom- 
inent leaders of the Church—the existence 
of decidedly psychopathic symptoms, more 
especially in the saints of the Roman 
Catholic Church. I will quote some of his 
examples. 

St. Anthony was a man of highly sensi- 

[209] 


Morbid Mental States 





tive nature, and with a tendency to auto- 
matic psychic movement. At the age of 
twenty he was seized by the suggestive vi- 
olence of the words: Sell all that thou 
hast and give to the poor. He became a 
hermit, fled away into the desert, and gave 
himself up to penance and meditation. 
Here he experienced terrible internal con- 
flicts, where storms of temptation over- 
whelmed him, one after another; at times 
his sensations attained such a degree of in- 
tensity as to produce hallucinations; he 
heard the voice of Christ, was whipped by 
devils and terrified by ghosts, and suffered 
great torment of mind. 

St. Francis of Assisi was likewise of a 
highly sensitive temperament, and highly 
susceptible to suggestion. This is evident 
from several incidents in his life. It is 
related that when communicating he often 
fell into a state of ecstasy, in which his soul 
was lifted up and longed for God. Often, 
when praying, he would fall into an ec- 

[210] 


Religion and Mental Degeneration 





static state, and, when considering the suf- 
ferings of Christ, fell into such a fit of 
weeping that his eyes were affected. He 
has written some songs which in their 
highly sensitive nature and almost physical 
surrender to the divinity produce an un- 
canny effect, and show that he was highly 
psychopathic. 

William James relates of George Fox, 
the founder of the Quaker religion, that he 
was a psychopath of the purest water. 
He gives the following example: Fox was 
once impelled by the word of the Lord to 
enter a city where he heard voices telling 
him to take off his shoes. It was winter, 
but he heard the word of the Lord re- 
peatedly crying, “Woe, woe unto Lich- 
field, the ungodly city!” When he 
reached the market-place, he saw a river of 
blood flowing across it; he seemed to be 
wading in blood, but the word of the Lord 
so burned his feet and body that he could 
not put on his shoes. 

[211] 


Morbid Mental States 


But we need not go to the Catholic 
saints for psychopathic symptoms; Mar- 
tin Luther himself suffered from the same. 
At twenty-seven he began to suffer from 
headache, giddiness, and noises in the 
head; this was repeated at different peri- 
ods of his life, and sometimes accompanied 
by hallucinations. In 1521, when he was 
living a very solitary life, he heard one 
evening some hazel nuts in a bag moving 
about of their own accord; they rushed up 
to the roof and toward his bed. Later, 
when he had fallen asleep, he heard a vio- 
lent crash, and starting up from his bed, 
he cried: ‘Who is there? I commend my- 
self to Jesus Christ!” Several times in 
his life he heard his own thoughts repeated 
aloud, sometimes in a voice of thunder, and 
“not infrequently,” he relates, “it hap- 
pened that I awoke at midnight and dis- 
puted with Satan until it was nearly time 
for Mass.” It is also a well-known fact 
that at the Wartburg, in a moment of ex- 

[212] 


Religion and Mental Degeneration 





treme spiritual tension, he threw an ink-pot 
at the devil. 

There is thus no doubt that William 
James may be right in asserting that many 
highly religious and spiritually creative 
persons have been psychopathic, or, as we 
may also put it, suffered from superior de- 
generation. It seems as if rare and ex- 
alted original ideas, those which really cre- 
ate new values, arise for the most part in 
the “crazy” brain, while persons of a ro- 
buster nervous system never get beyond 
ordinary every-day intellectual achieve- 
ments. 

What are we to say to this? Is there 
anything here derogatory to the great 
minds or to religious feeling? 

Not at all. The manner in which spir- 
itual results are achieved is immaterial in 
comparison with their value. It is the 

1It has been suggested that Luther was a manic- 
depressive subject, but it is doubtful whether this 
is correct. Possibly, Luther should rather be re- 
garded as psychopathic. 

[213] 


Morbid Mental States 


fruits of experience which count, not the 
intellectual mechanism which produces 
them. As William James points out, if 
St. Theresa had been endowed with a nerv- 
ous system like that of the most peaceable 
cow, it would not have saved her theology, 
provided it had proved unsound by the test 
of intellectual judgment. On the other 
hand, if her theology stands the test, it 
does not matter how hysterical and nerv- 
ously unbalanced she may have been while 
here on earth. 

It is of the utmost importance to realize 
this. For it counteracts the shallow medi- 
cal materialism which aims at reducing all 
spiritual values to something inferior, on 
the ground that they are based on a physi- 
cal, organic process. It is to the lasting 
credit of William James that he main- 
tains emphatically that it is arbitrary and 
illogical to deny the superior spiritual 
value of a religious mood because it can be 
shown to have an organic cause. If there 
be any such thing as inspiration from 

[214] 


Religion and Mental Degeneration 


above, says James, it may well be that the 
neurotic temperament provides the main 
requirement for susceptibility. 

On the other hand, this does not mean 
that the sane and ordinary, the needs of 
every-day life, are not also justified both in 
the life of the Church and in that of the 
individual. It is possible, indeed it is cer- 
tain, that the Church has generally fa- 
vored the psychopathic, and under- 
estimated what was ordinary and straight- 
forward. The Church should always bear 
in mind that certain persons, by virtue of 
their whole psychic construction, are al- 
together debarred from certain forms of 
religious experience. It is therefore al- 
together unfair to demand the same form 
of religious experience in all, for the psy- 
chic disposition differs greatly in different 
persons, and their religious experiences 
must therefore differ accordingly. If 
only we could always remember this, there 
would be less strife and dissension between 
the different schools of thought in the 

[215] 


Morbid Mental States 


Church, since every one would have enough 
to do in getting the best out of his own tal- 
ent and attaining what his qualifications 
permit in his own particular case. 


And here I conclude these lectures on 
morbid mental states in their relation to 
religious life. 

I am well aware that what I have been 
able to put forward in this field is poor 
and incomplete in comparison with the 
depth and importance of the subject it- 
self. But I have throughout made it my 
endeavor to arouse a keener interest in 
psychiatric and neurological study, and 
induce others to go further on their own 
account. For there can be no doubt that 
at the present day it is useful, indeed nec- 
essary, for theological students and the 
clergy to acquire more information on this 
head. 

We live in an age when religious long- 
ing is strong enough, but does not always 
turn toward the Church. What is the 

[216], 


Religion and Mental Degeneration 





reason of this? Is it not that the Church 
does not always turn toward the religious 
longing? It does not try to regard each 
individual human being according to his 
or her individual character and capacity, 
with all peculiarities of psychic structure. 
The Church has often endeavored to put 
people into a definite spiritual uniform; 
but people nowadays will not wear uni- 
form. They cannot and will not adapt 
themselves to anything of the sort. They 
must be themselves also in their religious 
life. And they have the right. 

Consequently, the clergy of to-day must 
learn to understand the different human 
types. And among these types there is 
one which is not the least important, and 
which the clergy should not neglect, 
namely, that of the morbid mind. 


[217] 








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